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If you have any questions about buying Practitioner products then email us at hello@purehealthvitamns.com or call us on +61410331331

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)

Do you smoke? If so,how many a day?

How many standard drinks do you consume per week?

How many times a week do you exercise?

What sort of exercise/activity do you do?

Please list any allergies you have.

Are you pregnant?

Are you breast feeding?

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

Other Medical conditions-Give details:

Supplements

Other and/or referring practitioners you see and why?

Practitioner’sname

Phone number

E-mail address

Address

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Body Glue Boost

Gevity Bone Broth

BONE106-1

As low as $36.00

Qty

- +

Go harder for longer with the first ever gut-friendly energy boosting formulation crafted from all-natural ingredients. Combining amino acids for muscle repair, nitrate dense beetroot for high performance and the fuel of MCT oil, you can power through even the most challenging workouts while giving your body the nourishment it needs to thrive.

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Designed for athletes, busy workers and anyone looking to really push the limits, Boost is quite possibly the only gut friendly pre workout that improves your overall health. Made with Nitric Oxide boosting beetroot and MCT oil, it has all the essential nutrients and slow-release energy needed to keep you going all day long.

100% Grass-Fed Beef Bones, Naturally Evaporated Sea Salt, Organic Beetroot Powder, Medium Chain Triglycerides.

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