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KateStewart

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Limited Consult - Acute Condition

First Name

Last Name

Email

What is your health concern?

When did it start?

What makes it better, worse?

Have you had it before?

Any health or lifestyle changes in anything prior to this?

Anything going on that I should know about?

Are you on any herbal formulas or medication currently?

Thank you so much for taking the time to fill this out as thoroughly as you can!

I look forward to helping you feel better!

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