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Below you will see a drop-down menu to select "Reason for Contact", which is important so we can gather the proper information to help with your request. Any questions about health require the "Consultation" selection to open up the other questions we need answered.  

We also offer a more complete detailed consultation by email from one of our health care practitioners. Many of our customers have been able to reverse their health problems by completing our complementary System Survey. This choice is for the more chronic complicated problems that our simple consultation below can not handle. You can learn more about the System Survey here.  

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Operating Hours:
Monday - Friday 9:00 to 5:00
Saturday 9:00 - 5:00

Order Online or Call:
Tel: (310) 395-1131
Fax: (310) 395-7861
 

Authorized Healthcare Provider

Reason for Contact

*

Intestinal problems

Gas Bad odor Bloating Pain Constipation

Is this consultation for you personally?

Yes No

Height

*

Weight

*

What is your reason for this email consultation?

*

How long have you been suffering with this problem?

*

List all symptoms

*

Have you seen a healthcare practitioner on this problem? If so, what did they recommend?

Do you have any dental problems?

Yes No

If yes, explain

Do you have any sleep problems?

Yes No

If yes, explain

What is your stress level?

5 or less being mild to moderate 6 or more being severe or chronic

List all diagnosed medical problems

*

List all medications you are taking for all health problems

*

Does your family have a history of these health problems?

Yes No

List all supplements you are taking including the brands

*

First Name

*

Last Name

Email

*

Email Verification

*

Phone

Cell Phone

Is this phone number able to receive text messages?

Birth Sex

Male Female *

Date of Birth

Age

Food

Gluten free
Vegetarian/Vegan

Zip Code

*

Are you interested in one of the following product lines?

Apex Energetics
Evergreen
Ortho Molecular
Sanesco
Standard Process
Systemic Formulas
Xymogen

Have you had any vaccines since 2021?

Yes No *

Prescribing Doctors Name

Additional Notes

 

 

 

   
*Required field