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We adhere to strict privacy standards and security measures. All submitted information is encrypted and kept strictly confidential and will never be shared or sold to third parties.
Why do we collect this information? This information ensures any products recommendations our herbalists make are tailored specifically to your unique needs and concerns, and that all compounded herbs are dispensed in a safe manner.
01. Medical History (check all that apply):
02. Do you have or suspect to have any of the following tick-borne illnesses? (check all that apply):
03. Are you pregnant?
04. Do you have any known drug/herb or environmental allergies?
05. Are you taking any medications?
06. Are you taking any supplements?
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