Request a Consultation

Please use the form below to provide as much information about yourself as possible for the herbalist to review.

This form is for FIRST TIME consultation request only. If you are existing patient, use "Contact Us" page.

It is important to email your pictures of your face and tongue after submitting the form for more accurate evaluation, unless you are already scheduled to see the herbalist in person within 2 - 3 days or so.

i.e. 08-26-1970

If your spouse has already submitted the form, do not use his or her email address. It will overwrite your spouse's file.

i.e. WA, CA, NY

i.e. United States, Canada

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