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5-MTHF 5 mg
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Berberine – 1000 mg
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Super EPA425 mg EPA with 270 mg DHA
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1. I am voluntarily providing my health and personal information to ELMNTL for the purposes of wellness optimization, functional medicine analysis, and/or related services. 2. My information will be handled with strict confidentiality and in accordance with HIPAA regulations and all applicable data privacy laws. 3. The services provided by ELMNTL are not a substitute for medical care by a primary care physician or specialist. 4. Any recommendations made are for educational, lifestyle, and performance purposes and are not intended to diagnose, treat, or cure any medical condition unless explicitly directed by a licensed provider. 5. I certify that the information I provide is true and accurate to the best of my knowledge and I am submitting it willingly and without coercion. 6. I have read and understand this disclaimer and agree to proceed.
I consent to ELMNTL collecting and using my information for wellness and functional health services.
I acknowledge that this information will be protected under HIPAA compliance.
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I confirm that the information I provide is accurate and that I am submitting this form voluntarily.
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