Mini Consultation Form

Please note that in accordance with Health Canada's new regulations, the sale of all herbal tinctures, capsules, and creams now require a consultation prior to purchase. Our complimentary consultations are conducted via phone or email for your convenience. All customers are required to fill out the form below, and we will accommodate your request to the best of our ability.

For customers seeking custom formulations, please utilize this same form. Please try your best to focus on one health concern during your consultation to let our team give it our full attention.

If our complimnentrary consult insnt enough, we offer full herbal and nutrition consultations. For more information on full consultations please see our services page.

What is the main reason for the consultation?*

Purchasing Herbal Tinctures, Creams, CapsulesCustomized FormulasGet to Know a PractitionerGeneral Information

Name*

First NameLast Name

How would you prefer we conduct the consultation?*

EmailPhone

Email

example@example.com

Phone Number

Area CodePhone Number

Please indicate if you fall under any of the following categories

Naturopathic DoctorHerbal Medicine PractitionerHerbal Medicine StudentOther Natural Healthcare Provider

In brief words please share what you are looking to get support with? *

Are there specific herbs you are interested in or looking for?

Are the herbs you are looking for prescribed by a healthcare practitioner?*

YesNo

Do you have any underlying health conditions? If so, please list.

Are you taking any prescription medications? If so, please list.

Do you have any allergies? If so, please list.

Thank you for taking the time to fill out this form. We will get back to you within the next 24-48 hours to best support your request based on the information provided.

Discretion is important to us. Apotheka Herbal Boutique will never share your personal information with any third party without any written request/consent to do so. We look forward to getting to know you.