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Herbal Tea Bags Calendula

Planet Organic

Description

PLANET ORGANIC Herbal Tea Bags Calendula - 25

Ingredients

Calendula Flowers.

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

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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

Asthma

Chemical sensitivities

Coeliac disease

Diabetes

Epilepsy

Glaucoma

Heart Condition

High blood pressure

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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Herbal Tea Bags Calendula

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