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Bespoke remedies consultation form 


PERSONAL DETAILS
Full Name *
Full Name
It can provide a great insight into your lifestyle, stress levels, activity leves, etc.
It can provide a great insight into your lifestyle, stress levels, activity leves, etc.
YOUR SYMPTOMS
Often symptoms start after a stressful or traumatic life event, prolonged stress, birth, chronic vaginal infection, injury or prolonged use of medication, like antibiotics.
YOUR STORY
YOUR BODY
YOUR MIND
SELF CARE
ADDITIONAL INFORMATION

By submitting the above form you acknowledge that:

- I am not a medical practitioner

- I do not claim to diagnose or cure any medical conditions

- My remedies are designed to support your wellbeing