Swanson WEB TECHNOLOGIES
Powering Today's Web Sites with Exquisite Beauty and Superb Functionality
presents...
Patient Wellness Registration
First Name*:
Last Name*:
Email*:
Medicine Type Prescribed:
Indica
Sativa
Hybrid
Primary Medical Condition for this treatment:
Digestive
Psychological
Pain
How helpful has your medicine been to date?
None
Somewhat
Satisfactory
Very
Excellent
Your health and feeling of well-being are very important to us.
How can we serve you better?
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