Do you experience low energy?

Never

1-2 times per month

Weekly

Daily

Do you suffer from a sluggish metabolism?

Never

1-2 times per month

Weekly

Daily

Do you experience low mood?

Never

1-2 times per month

Weekly

Daily

Do you suffer from brain fog or trouble concentrating?

Never

1-2 times per month

Weekly

Daily

Do you have thinning hair or eyebrows?

Yes

No

Do you suffer from low motivation/ambition?

Never

1-2 times per month

Weekly

Daily

Do you experience dry skin?

Yes

No

Do you suffer from water retention or puffiness?

Never

1-2 times per month

Weekly

Daily

Do you experience cold hands/feet?

Never

1-2 times per month

Weekly

Daily

Do you suffer from menstural cycle irregularities?

Yes

No

Do you have high cholesterol?

Yes

No

I Don't Know

First Name *

Email *

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