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Solid Shampoo Bar Dry Hair

The Australian Natural Soap Company

The Aust. Natural Soap Co Solid Shampoo Bar Dry Hair

Sodium Prunus Amygdalus Sativa Kernel Oil, Sodium Macadamiate, Sodium Olivate, Sodium Cocoate, Sodium Arganate, Mentha Piperita (Peppermint) Oil, Lavendula Latifolia (Lavender) Oil, Salvia Sclarea (Clary Sage) Flower Oil.

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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

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)

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Medical History

Arthritis

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Coeliac disease

Diabetes

Epilepsy

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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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Solid Shampoo Bar Dry Hair

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