Customized Herbal Formula starts at $60.75

$67.13 $60.75
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Custom Herbal Formula by Hen Harpaz Hi, I’m Hen Harpaz, a licensed acupuncturist and board-certified clinical herbalist with over 15 years of experience in Eastern...
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Custom Herbal Formula Request

Please fill out this form to request a custom herbal formula. For a more detailed diagnosis, schedule a phone or in-office consultation.

Personal Information

Upload Your Tongue Photo for Diagnosis.

In Eastern Medicine, tongue appearance reveals your body’s internal condition. Please upload a clear photo of your tongue, as shown below.
For women, check here if you are pregnant:
Pregnant
Health Assessment

Main Health Concern:

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Symptoms (Optional, but greatly helps with diagnosis):

Hot flashes
Night sweats
Dry eyes
Dizziness
Ringing in ears
Trouble sleeping
Heart racing or pounding
Memory loss
Extreme tiredness
Low energy
Frequent colds/infections
Feeling chilly easily
Disliking cold environments
Sweating without effort
Shortness of breath
Diarrhea
Bloating/gas after meals
Lightheadedness
Decreased appetite
Frequent urination
Weak back/knees
Easily annoyed
Frequent anger
Red face/eyes
Mouth ulcers
Rib-side/abdominal pain
Pressure in the head
Worry or nervousness
Depression
Dry mouth
Poor concentration
Cold hands/feet
Sharp pain
Feeling of heaviness
Chest tightness
Sticky/phlegmy cough
Lots of mucus
Everyday
Constipation
Diarrhea
Both Constipation and Diarrhea

Consent

  • I understand that custom herbal formulas are carefully crafted and may affect individuals uniquely; I agree to follow the usage guidelines.
  • I will inform Purely Natural Remedies if I am pregnant or trying to conceive.
  • I understand this is a basic online assessment...
  • I consent to sharing my health information for this assessment.

Certified GMP • Kosher • Vegetarian
Free of sulfur, pharmaceuticals, preservatives, fillers
Independently lab-tested for heavy metals, pesticides & microbes

Pickup available at Shop location

Usually ready in 2-4 days