Supplement Access Request

Before we open access to the Atomic Thrive clinic dispensary, we need a quick health overview to ensure practitioner-only supplements are used safely and responsibly.

Please share your current medications, supplements and any health conditions. Our naturopath will review your information and you may receive a short follow-up call from Dane (our naturopath and co-founder) if anything needs clarification. After approval, we’ll send you a welcome email with next steps, so please check all your folders.

If you’re looking for deeper support — from blood work to biomarkers to full health optimisation — you can book a consult with Dane at any time.

Your name

Your surname

Your email

Phone number

Which health area are you seeking support with?

Are you taking any prescription medications (e.g. antidepressants, blood pressure medication, blood thinners, pain medication, etc)

Yes

No

Do you have any health or medical conditions (e.g. chronic disease, diabetes, pregnancy, breastfeeding, etc)

Yes

No

List any allergies, intolerances or sensitivities

How did you hear about us?

Untitled checkboxes field

I confirm that I have shared accurate and complete health information.

This form is required to ensure safe and appropriate access to practitioner-only supplements. The information you provide will be reviewed by our naturopath and you may be contacted if clarification is needed. By submitting this form, you confirm the information provided is accurate and complete. This form does not replace personalised medical or naturopathic advice.