Native Genetics Wellness Questionnaire

Create Your Wellness Profile

Creating your Natural Wellness profile for natural wellness consultants, we require some personal information including your blood type. Please complete the wellness questionnaire fields below. You will be registered as a Native Genetics wellness client, which will allow you to manage your profile information and more.

Account

Personal

Experience

Last Page

Username *

First Name *

Last Name *

Email *

Fill required fields

phone *

Country *

Personal ID Number *

Date of Birth

Age *

Blood Type

O+

O-

B+

B-

A+

A-

AB+

AB-

Gender *

Fill required fields

How much experience do you have with Plant Medicine? *

None

Less than 2 weeks

Between 2 weeks and 3 months

Between 3 months and 6 months

Between 6 months and 1 year

1 to 3 years

3 to 5 years

5 years +

Your Experience with Plant Medicine and Natural Wellness Treatments *

Tell us more about your experience with natural wellness solutions, plant medicine treatments and your experience before considering Native Genetics.

Plant Medicine Interests *

General Wellbeing

Natural Wellness

Recreational Use

Medicinal Use

Specific Treatment

Fill required fields

Additional Information for Consultation *

Please provide any additional context for your Wellness Consultant to consider.

Are you interested in contributing to Research and Development for Plant Medicine? *

Yes

No, thank you

Reason for Completing this form *

To be an online store customer and shop online (default)

To be a Native Genetics club member and gain access to more.

To be a Native Genetics wellness consultant and enter our screening and qualifications process