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Your health assessment in 2 minutes flat

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What is your email?

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What is your first name?

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What is your date of birth?

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What is your gender?

Male

Female

Other

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Are you affected by any of the following?

I am pregnant

I am in perimenopause

I am in menopause

No

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Regarding supplements, you are?

Informed

Curious

Skeptical

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Your goal?

Soothe joint pain

Manage stress better

Boost immunity

Have more energy

Improve digestion

Beautiful hair & nails

Healthy skin

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When do you feel pain?

In the morning upon waking

During physical effort

At rest

All the time

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Do you have a family history?

Yes

No

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How does your stress manifest?

I get stressed in certain situations

I'm naturally anxious, anything stresses me

I'm under constant stress

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How would you describe your stress today?

Low

Moderate

High

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What are the daily impacts of this stress?

Digestive issues

Irritability

Mood swings

Disturbed sleep

Irregular heartbeat

Other

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Do you feel tired?

No

Sometimes

Often

All the time

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Do you often get infections?

1 to 2 times a year

More than 2 times a year

Rarely

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How do these infections manifest?

ENT-related

Urogenital area

Skin-related

Other

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Do you feel tired?

Good for you

Sometimes

Often

All the time

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How is your sleep?

I sleep well

I have trouble falling asleep

I wake up feeling tired

I wake up often

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What’s the reason?

I have pain

I need to urinate

I overthink

I have nightmares

I get cramps

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How often do you have bowel movements?

Once a day

Several times a day

2 to 3 times a week

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Do you suffer from digestive discomfort?

Gas, bloating

Acid reflux

Abdominal cramps

Nausea, vomiting

Diarrhea, loose stools

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Do you have any food intolerances?

None

Gluten

Lactose

Nuts

Shellfish

Other

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What is your top priority?

Hair

Nails

Both

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What is the condition of your hair?

My hair is dull

My hair is brittle

I’m losing my hair

I have dandruff

I suffer from itching

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What is the condition of your nails?

My nails are brittle

My nails split

My nails are ridged

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What is the condition of your hair?

My hair is dull

My hair is brittle

I’m losing my hair

I have dandruff

I suffer from itching

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What is the condition of your nails?

My nails are brittle

My nails split

My nails are ridged

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What skin problem concerns you?

Allergies

Eczema / Psoriasis

Neurodermatitis

Itching

Acne

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What is your physical condition?

Full of energy

Tired

Very tired

Exhausted

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What is your mental state?

Feeling great

Stressed

Depressed

Irritable

Other

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What is your eating style?

I eat healthy and balanced

I sometimes indulge

I don’t pay much attention

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Tell us more

I often skip meals

I have cravings (sweet or salty)

I eat very large portions

I feel sleepy after meals

Other

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Do you follow a specific diet?

Non

Vegan

Vegetarian

Plant-based

Flexitarian

Ketogenic

Gluten-free

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Do you drink alcohol?

Never

Sometimes

Once a day

Several times a day

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Do you have any health issues?

None

Depression

Thyroid disorders

Cardiovascular issues

Digestive issues

Cancer

Degenerative diseases

Allergies

Anemia

Sleep disorders

Kidney failure

Osteoarthritis

Arthritis

Osteoporosis

Autoimmune diseases

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Other

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Are you being treated for these issues?

By a doctor

By a therapist

By a naturopath

No

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Are you following a treatment?

Medical

Alternative medicine

Food supplements

Self-medication

No

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