Do you suffer from frequent headaches?
Never
1-2 times per month
Weekly
Daily
Do you experience menstrual cycle dysregularities?
Never
1-2 times per month
Weekly
Daily
Do you suffer from anxiety?
Never
1-2 times per month
Weekly
Daily
Do you experience brain fog?
Never
1-2 times per month
Weekly
Daily
Do you suffer from feelings of depression?
Yes
No
Are you experiencing deteriorating eye health?
Yes
No
Do you suffer from poor immune function?
Yes
No
Do you experience tingling in hands and feet?
Never
1-2 times per month
Weekly
Daily
Do you suffer from kidney issues?
Yes
No
Do you experience memory problems?
Never
1-2 times per month
Weekly
Daily
Do you suffer from digestive issues?
Yes
No
Do you experience shaking or trembling of hands?
Never
1-2 times per month
Weekly
Daily
Do you suffer from thyroid imbalances?
Yes
No
Do you experience prostate inflammation (men)?
Yes
No
N/A
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Email
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