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Attentive Counseling, Confidential Patient InformationDRIVERS LICENSE # HEALTH INSURANCE POLICY #, GROUP #, ID # Name: (Last)(First)(Middle Initial)Name of parent/guardian (if under 18 years): (Last)(First)Birth
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Natural plant extracts forms typically require information such as the source of the extract, extraction methods used, and any additives or preservatives included.
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Information such as the botanical name of the plant, extraction solvent used, concentration of active compounds, and any potential allergens must be reported on natural plant extracts forms.
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