「李氏御方」個人健康諮詢表 Personalized Body Constitution Analysis & Consultation Form
This form is used to set up your personal health conditions profile at Li Natural Healthcare. All information provided will be kept strictly confidential. It is used solely for analyzing your body constitution in details by the health professionals in order to best help you customize the most suitable treatment plan. Please complete it to the best of your knowledge.
The service includes profile setup, personalized analysis, initial herbal formulation prescription, dietary / exercise recommendations. Herbs, shipping and handling incur separate fees.
Fees for a Full Body Constitution Analysis is $50 for new patients, $30 for existing patients.
- Paypal: email@example.com (choose "send to a friend")
- Zelle (bank transfer): BofA, Li Natural International LLC, firstname.lastname@example.org, 424 258 0335
- Venmo: @LiNatural-Healthcare
- Check: Li Natural International LLC, 1049 El Monte Ave, SteC#596, Mountain View, CA 94040
- Cash: in person
For more info, visit: www.linatural.health
名 First Name
生日 Date of Birth
收件地址 （若與以上地址不同）Postal Address (If different from address above)
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