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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

Home
FAQ Centre
How to Purchase Practitioner
How do I upload my script?

How do I upload my script?

Sign up / Sign in to your FREE account
Once you have logged in, go to My Script in your customer dashboard (My Account)
Click Upload Script and attach the file / scanned document or photo of your script and save

Once you have uploaded required documents / photos, the team at Pure Health will review your application.

You will receive an email notification from the PH Team to inform you whether your script has been verified within 24 hours. Once approved, you will be able to view product details, add to cart and complete your online purchcase.

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