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Product Total Quantity Total
Foundation
Foundation
$69.00
Style:
30 Caps Jar
    $69.00
    $69.00

    Medical Questionnaire

    Please complete this short medical questionnaire that allows our pharmacist to assess suitability for the products and compound your supplements specifically for you.

    Are you a returning customer?
    Are you currently on any medication?
    Do you have any pre-existing medical conditions?
    Do you suffer from any allergies?
    Are you currently pregnant or breastfeeding?
    Who are these products for?
    Is there any other information you’d like to disclose?
    Email address

    Email must be the same as checkout and order.

    I confirm that I have provided the information requested above truthfully and to the best of my current knowledge. I also understand that my supplements are individually compounded and providing accurate information is solely my responsibility.