Do you suffer from poor vision?
Yes
No
Do you experience dry, scaly, or itchy skin?
Never
1-2 times per month
Weekly
Daily
Do you suffer from fertility issues?
Yes
No
Do you experience more frequent infections?
Yes
No
Do you suffer from acne and breakouts?
Never
1-2 times per month
Weekly
Daily
Do you experience poor wound healing?
Yes
No
Do you suffer from poor vision at night?
Yes
No
Do you experience stunted growth in children?
Yes
No
N/A
First Name
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Email
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