Practitioner 
Formulation Request Form (PRF)

I am 21 years or older. I am a liscensed and/or certified practitoner. I understand  and agree that by purchasing this product I am responsible for the outcome of results as it pertains to my personal practice and the health of patients/clients. I understand that this product has not been approved by the FDA, and is not intended to cure, treat, or prevent any disease. I understand that these products under most circumstances are contraindicated for pregnancy.