Travel Kit Health Questionnaire

Name *
Name
Address *
Address
Include all allergies to medications and food
Are you vegan/ vegetarian/ gluten free? *
Please list ALL medications and supplements you take
Include chronic conditions, autoimmune diseases and relevant health information. The more information you provide the better.
At home or while traveling do you experience? *
Check all that apply
When you get a cold what symptoms do you most often experience? *
Check all that apply
What temperature are you normally? *
Please use the Pay Pal button below to purchase your Travel Kit *
*Without payment your request can not be processed and you will not be guaranteed to receive your kit on time.

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