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Tulsi Masala Chai

Organic India

Description

BENEFITS

Tulsi: India's beloved Queen of Herbs for 5,000 years.
Adaptogenic Tulsi supports a healthy stress response.
Classic chai spices cinnamon, ginger, cardamom, pepper, clove, and nutmeg combined with black tea and Tulsi.
Contains Caffeine | Gluten Free

About the Brand

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Practitioner Health Questionnaire

Name

Age

Gender Male Female

Primary Health Complaint

Describe your symptoms,including frequency and duration

When did they start?

Is there any thing that them better or worse?

Is there a family history of these symptoms ?

Diet and Life style

How many hours do you sleep at night?

What is the quality of your sleep(out of 10,where 10 is best quality)

General stress levels(out of 10,where 10 is the highest)

Overall diet(out of 10,where 10 is the healthiest)

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Please list any allergies you have.

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Medical Conditions:Do you have any of the following? Yes No

Medical History

Arthritis

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Coeliac disease

Diabetes

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Lactose in tolerance

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Supplements

Other and/or referring practitioners you see and why?

Practitioner’sname

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Address

Tulsi Masala Chai

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BENEFITS

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