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Child Supplement Health Questionnaire
Please fill out a health questionnaire and release form for each individual child who will be consuming our supplements. We advise each parent and child to seek medical counsel from his or her pediatrician prior to taking any supplements. If you would like a more detailed consultation with respect to supplements, please email
hello@postpartumslimdown.com
.
*
Indicates required field
Child Name:
*
First
Last
Parent Name:
*
First
Last
Parent Email:
*
Parent Phone Number:
*
Child Age:
*
Supplements of Interest (may choose more than one):
*
Children's Multi-Vitamin
Children's Vitamin D3
Children's Omega
Children's Probiotic
Children's Nutrition Powder
Baby Probiotic
Baby D3
Other
Please list any medications and/or supplements your child currently takes or has taken within the last year:
*
Please list if your child has had or currently has any preexisting health conditions:
*
Please list any allergies, sensitivities or intolerances to foods and/or medications your child has:
*
Anything else we should know?
*
Please select how you would like to be communicated with on behalf of your child:
*
Text
Email
Phone
By submitting this form, I certify that all of the information provided is true and accurate. I consent that I have read all information regarding each supplement being purchased, including ingredients, labels, warnings, allergens, dosages, age/height/weight requirements, and release CATE AND ILA, LLC from any harm that may ensue as a result of my child consuming the supplements purchased on this site.
*
I AGREE
Submit
HOME
SLIMDOWN SHOP
SUPPLEMENT SHOP
HEALTH QUESTIONNAIRES
POSTPARTUM SLIMDOWN HEALTH QUESTIONNAIRE
CHILD SUPPLEMENT HEALTH QUESTIONNAIRE
ADULT SUPPLEMENT HEALTH QUESTIONNAIRE
TESTIMONIALS
ABOUT
ABOUT
>
MEET THE FOUNDERS
CONTACT