Do you experience anal itching?

Never

1-2 Times per Month

Weekly

Daily

Do you suffer from nausea?

Never

1-2 times per month

Weekly

Daily

Do you experience bloating?

Never

1-2 times per month

Weekly

Daily

Do you suffer from diarrhea?

Never

1-2 times per month

Weekly

Daily

Do you experience vomiting?

Never

1-2 Times per Month

Weekly

Daily

Do you suffer from dehydration (electrolyte loss)?

Never

1-2 times per month

Weekly

Daily

Do you experience malnutrition?

Never

1-2 times per month

Weekly

Daily

Do you suffer from skin rashes?

Never

1-2 Times Per Month

Weekly

Daily

Do you experience teeth grinding?

Never

1-2 times per month

Weekly

Daily

Do you suffer from migrained/headaches?

Never

1-2 times per month

Weekly

Daily

Do you experience eczema/psoriasis?

Never

1-2 Times Per Month

Weekly

Daily

Do you experience unwanted weight loss?

Yes

No

Do you suffer from acne?

Yes

No

Do you suffer from joint pain?

Never

1-2 times per month

Weekly

Daily

Do you experience fatigue (anemia)?

Never

1-2 times per month

Weekly

Daily

Do you suffer from an imbalanced immune system?

Never

1-2 Times Per Month

Weekly

Daily

Do you experience allergies?

Never

1-2 times per month

Weekly

Daily

Do you suffer from asthma?

Never

1-2 Times Per Month

Weekly

Daily

Do you suffer from forgetfulness (high cortisol/adrenaline or really low cortisol)?

Never

1-2 Times Per Month

Weekly

Daily

Do you experience depression (gut-brain axis)?

Never

1-2 Times Per Month

Weekly

Daily

Do you suffer from increase immune response (auto immune)?

Never

1-2 Times Per Month

Weekly

Daily

First Name *

Email *

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