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LEVEL II NEW PATIENT QUESTIONNAIRE - ENGLISH - APRIL 2021

 

Welcome !

 

Permitaan Pengobatan Paket Bahasa Indonesia, Mengklik Disini

 

Use this form if you are requesting Deep Health Analysis, and also requesting Level II Membership with BSI.

 

Level II is all about detoxifcation and rebalance of body systems. This is how we begin most therapies at BSI. 20 minutes are generally needed for completion, and you can stop and save when needed, and finish later.

 

We will preform detailed analysis based in part on your detailed responses. Accuracy is key.

 

All Information Remains Confidential.

 

BSI Home Page  

 

Instructions

After you answer a few questions, save your Questionnaire by clicking on the “Resume Later” button at the top of the screen. It’s important you enter a valid email address. Make sure there are no extra spaces before or after the name and password, as blank spaces will be added to them. You will be sent a link to re-enter the survey and continue where you left off. If you have not received a link email, check your email spam filter.

Also, if you need to leave the survey for more than 10 minutes, be sure to click “Resume Later” so that your responses will not be lost. This is a necessary security function.
If the session has expired, log in again using the address you were sent via email.

Recommended protocols to ensure the New Patient Survey is properly received, and to save you time: 

1) We highly suggest you use a PC computer with a stable internet connection. Best not to use an Ipad, smart phone, tablet, etc. If the WIFI signal is lost on these devices, the server may reset.

2) We suggest you view the BSI.international website via an up-to-date Firefox Browser.

3) Enable JavaScript on the browser. Without Javascript, the Questionnaire cannot interact with the BSI server to save your responses.

4) You may need to disable ad blockers on BSI.international for proper function. No ads or tracking are contained in the New Patient Questionnaire.

5) If you see the "One or more mandatory questions have not been answered. You cannot proceed until these have been completed" notice, then scroll down to the section and answer what is highlighted. If none apply, then check the box at the bottom of the screen that may be labeled as "none, or not sure", etc.).

6) If you need to leave the survey for more than 10 minutes, be sure to click “Resume Later” so that your responses will not be lost. This is a necessary security function. Your personal data must be protected.

7) If the session has expired, log in again using the address and password you were sent via email.

8) For your benefit, please fully answer all questions, as the basis of your analysis is a detailed medical history.

9) Remember to only click a button if the answer is yes. If the answer is no, then don’t click the button by that question.


BSI owns and operates a private, fully-secure server in Indonesia. It is not shared by any other entity. We do not use trackers or add advertising to the Questionnaire, nor allow access to patient data to anyone. No data is stored in the so-called “internet cloud”.

Thanks for your patience.