Custom Blend - OnePointe Botanicals

Custom Blend

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First Name

Last Name

Date

Occupation

Email Address

Phone Number

Please describe the symptoms(s) you are currently experiencing?

What area of the body are you experiencing the symptoms?

Have you had these symptoms for over 90 days?

What other solution are you using right now? Why are you looking to switch?

What other major health conditions do you have?

Are you currently in menopause?

What is your availability for a 15 minute call?

Please rate your level of agreement with the statement: “Natural remedies take time, but they are very effective.”

Do you typically get 6-8 hours of sleep daily?

How would you describe your stress/anxiety level?

How often do you detox your body systems?

Have you had any joint injuries within the past three (3) months?

Do you have a pacemaker or defibrillator implant (ICD)?

Do you have any recent wounds from an operation, surgery, or accident?

Do you have any metal plates, pins, implants, or rods?

Have you ever been diagnosed with cancer, diabetes, or a bleeding disorder?

Do you suffer from congestive heart failure?

Please provide additional information you want to share.

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