The Virtual Herbalist is for your convenience. It provides you with the opportunity to have a herbal prescription made specifically for your condition. So go ahead consult our virtual herbalist.

Natural skin care products by Wildcrafted Herbal Products

WILDCRAFTED HERBAL PRODUCTS

Your Natural Skin & Personal Care Solution


Natural skin care products by Wildcrafted Herbal Products

Virtual Herbalist

Natural Skin Care Products by Wildcrafted Herbal Products

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Introduction

If you are unable to come to our Kurrajong Natural Medicine Centre, then the Virtual Herbalist is designed for your convenience. By filling in this form you are providing the Virtual Herbalist with information about your health. The more detailed the information is, the better the Virtual Herbalist can assess your condition and make subsequent recommendations.

The Virtual Herbalist is actually a fully qualified, certified and experienced Medical Herbalist and is a valued staff member of Wildcrafted Herbal Products, so your information will not be assessed by some computer program, but rather a physician with extensive knowledge and experience.

If you wish to purchase products from our Therapeutic Range and you are resident within Australia, you need to complete this form before you can purchase the product you are interested in. This is a requirement under the Therapeutic Goods Administration (TGA) act.

Once you've completed the form, submit the form to us by clicking on the 'submit' button at the end of the form. Our medical herbalist will assess your case and if necessary make contact with you to clarify any uncertainties or to ask you some more relevant questions which will help in a diagnosis.

ALL INFORMATION SUBMITTED IS TREATED AS A MEDICAL RECORD AND NOT AVAILABLE TO ANYONE FOR ANY REASON AT ANY TIME.

Virtual Herbalist Consultation Form

 

 

 

 

Full Name:                     

Your Date Of Birth:     

Mailing Address:         

Phone Number:           

Email Address:            

Gender:                         


Do you suffer from any diagnosed medical conditions?
If so please specify
Yes - please name condition:
No




Are you taking any medications (please include Herbal Medications and or Vitamin supplements)?
No - please continue to next question.
Yes - If so please list, than continue to next question

Name / Brand of Medication        Dosage                             How long have you been taking this medication
                   

                   

                   

                   

                   

                   




Are you pregnant


No - please continue to next question.
Yes - If so, sorry we can not supply you with any of our Therapeutic products at this stage. Please consult your nearest Herbalist and enjoy your pregnancy. (Please note we do not prescribe herbal medicines to pregnant women we have not personally seen as patients.)


 

Do you suffer from any Allergies?

No
Yes - please give details of allergy:

Name / Brand of Medication        Dosage                             How long have you been taking this medication
                                    


Which of the Therapeutic Products are you interested in and why?  
1.     why?
2.     why?
3.     why?
4.     why?




What are your symptoms (eg: Headache, back pain, etc.) please give a detailed answer, you are not limited to the space indicated by the boxes. You can continue typing and we will receive all the information you provide.

Symptom(s)                                Period of time symptom has been present.
                                    

                                    

                                    

                                    

                                    

                                    

                                    

                                    



Please type any extra information, or questions you may have in the text box below


To make an appointment with one of our qualified natural health care professionals,
call: (02) 4573 0784

If you would like to provide us with additional information OR you would like to ask questions please sent us an email and we will get back to you as soon as we are able.

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Kurrajong Natural Medicine Centre

All our skin care products have been developed primarily to help our patients with a wide range of skin care problems for the past 30 years.

Susan and Danny practice Western herbal medicine, Acupuncture, Chinese herbal medicine, Remedial body therapies at their private practice in the lower Blue Mountains, West of Sydney.

Their combined experience in treating skin and other disorders is well over 50 years and they're happy to help you regain your optimal health.

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WILDCRAFTED HERBAL PRODUCTS
ABN 97 131 307 643

P.O. Box 111
Kurmond, NSW, 2757
Australia

email: Contact
phone: +61 2 4573 0784 - international
phone: (02) 4573 0784 - within Australia

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