Professional Product Screening Questionnaire
Thank you for your interest in our professional-grade products. Please be advised that due to the nature of these items, a health screening is required prior to fulfillment. Upon passing the screening, you will receive an email notification confirming that your product has been fulfilled and dispatched. If any concerns arise during the screening process, we will refer you to your healthcare provider. It is important to note that this process is not a substitute for proper medical care and does not establish a patient-practitioner relationship. The statements regarding the product have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. We strongly recommend discussing the appropriateness and usage of the product with your healthcare practitioner.

Privacy Policy: Your information is collected solely for the purpose of evaluating the appropriateness of the product. We do not sell your information to third parties. However, we may share your information with our affiliated businesses, such as DrBetsyGreenleaf.com, Greenleaf Nutriceuticals, and Greenleaf Health & Wellness. Rest assured that we will not send you spam emails. You are free to unsubscribe or subscribe to our email list at any time.
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Date of Birth: Year Only *
Full Address Street, Town, State, Zip *
Email: *
Preferred Phone Number and Type *
Gender *
Sexual Identity
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