Herbal Wellness & Oriental Medicine Online Clinic

Specializes in natural health solutions, Main in any Sleeping problems.

Contact

Contact

Contact Us

We’d love to hear from you! We’re here to answer your questions.

Get in touch

We’re here to answer your questions and listen to your suggestions.

Austin, Texas

6805 Wood Hollow Dr

Text : (737)296-7825

Email : [email protected]

All herbal ingredients are locally produced in the United States, strictly adhering to U.S. food safety regulations under the supervision of the FDA. Please use with confidence.

Thank you for your response. ✨

First Name*

Last Name

Email*

Phone Number

Part 1. Basic Information
Average Daily Sleep Duration

< 4 hours 4 ~6 hours > 6 hours

Tongue Color and Coating

Yellow, Greasy Coating Thick, Greasy Coating No Coating Pale Tongue Red Tongue

Primary Disturbances

Difficulty Falling Asllep Dreaming Disturb Sleeping Early Awakening with Inability to Fall Back Asleep Difficulty Sleeping Throughout the Night

Part II: Symptom Checklist

Irritability Mouth Ulcers Short, Dark Urine Easy Anger Chest & Hypochondriac Distension Abdominal Distension Bitter Taste in Mouth Heat Sensation in Palms, Soles, Chest Night Sweats Soreness and Weakness of the Waist and Knees Heavy Sensation in Head Vertigo Excessive Phlegm Palpitations Fatigue Poor Appetite Shortness of Breath Spontaneous Sweating Constipation Diarrhea Belching, Acid Regurgitation

Any Other Diseases? (e.g., Hypertension, Diabetes) :

Yes No

If Yes, Please Specify :

If You Are Taking Any Medications or Treatments, Please Describe :

By submitting this form, you agree to our processing of your data in accordance with our Privacy Policy.

Facebook

Copyright © 2024 Herbal Wellness & Oriental Medicine Online Clinic. All rights reserved.