Two Smudge Stick White Sage Mini

Luvin Life

Description

LUVIN LIFE Smudge Stick White Sage - Mini 12cm - 2

About the Brand

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Practitioner Health Questionnaire

Name

Age

Gender Male Female

Primary Health Complaint

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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

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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 History

Arthritis

Asthma

Chemical sensitivities

Coeliac disease

Diabetes

Epilepsy

Glaucoma

Heart Condition

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Inflammatory Bowel disease

Lactose in tolerance

Stomachulcers

Thyroid

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Supplements

Other and/or referring practitioners you see and why?

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