EmailMe Form - Herbal Health Jointcare Tester Pack (Facebook)

Name of Applicant *
First Last
Email Address of Applicant *
This will be the contact / follow-up email address. We will not share your email without your permission.
Contact Number of Applicant *
Please include country code. (eg. for United States +1-505-123-1234 / Singapore +65-6123-4567)
Mailing Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

The Herbal Health Jointcare 5-capsules Tester Pack will be sent to this address. Please ENSURE that you input the correct mailing address.
Are you applying for yourself or another patient? *
Myself
Patient
*Please note that if you are applying for another patient, you are solely responsible for their health suitability and use of this tester.
Name of Patient (If different from Applicant)
First Last
Age of Patient *
We do not encourage patients below the age of 12 to consume Jointcare
Gender (of Patient) *
Male
Female
Condition(s) that patient is suffering from *
Rheumatoid Arthritis
Osteoarthritis
Fibromyalgia
Gout
Rheumatism
Bursitis
Tendinitis
Other
If unsure, please select Other, and let us know what you are experiencing.
Is the patient suffering from any of the following medical condition(s) *
None
Heart Disease
High Blood Pressure
Kidney Disease
Liver Disease
As a precaution, we do not advise people who are suffering from serious heart conditions or severe kidney problems to consume Herbal Health Jointcare.
Remarks / Comments / Questions (If any)
Notes and Terms of Acceptance

- This offer is NOT valid for applicants in Singapore.
- The Herbal Health Jointcare Tester pack consists of 5-capsules, which is adequate for a normal 4-days consumption (Two capsules on Day 1; One capsule each on Day 2-4)
- Do not take Jointcare with hot/warm water and any form of painkillers.
- Most people usually experience significant improvements within the first couple of days after consumption.
- This herbal supplement has proven to help many people, but it is ultimately your own decision to make. *
I agree
I disagree
By selecting "I agree" above, you hereby confirm and agree that:

1) You (or on behalf of the patient) are requesting for this free tester pack at your own free will, and will consume at your own risk.

2) ACE Nutrition International (or any of its subsidiaries) will not be held liable for any adverse/negative effects upon consumption.

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