By submitting this form you are giving consent for Hinterland Naturopathy to collect and store your personal information as a part of your case file. This information is necessary for proper and effective Flower Essence Remedy.
All your personal information is treated with strict confidence.
You understand that a Naturopath doesn't diagnose illness, disease or any other physical and mental disorder and we do not prescribe medical treatment.
Payment in full of $25 includes postage must be made before dispensing of Flower Essence.