Checkout - Medical History Step 1 Customer Info --> Step 2 Physician Info --> Step 3 Med History --> Step 4 Order Details --> Step 5 Payment Continue Checkout Return to Cart Save Quote Cancel Order Has customer seen their physician in the past 12 months? Yes No   Customer Medical History   Blood Disorders Cancer Immune System Disorders Poor Wound Healing Neurological Disorders Hormone Disorders Nutritional, Mineral, or Electrolyte Imbalance Lipid/Cholesterol Disorder Heart/Circulation Disease Kidney/Urinary Disease Liver Disease Orthopedic or Muscle Disease Mental Disorders Surgical Procedures Glaucoma Addictions (Chemical) Airway Disease Smoker Lung Disease Arthritis, Lupus High Blood Pressure Diabetes Pregnant (Woman Only) Breast Feeding (Woman Only)   Other Conditions (Required)   Additional Medications Taken (Required) Continue Checkout Return to Cart Save Quote Cancel Order