Have you ever been diagnosed with a thyroid condition? *

Yes

No

Do thyroid problems run in your family? *

Yes

No

Do you have any issues with swelling or water retention (feet face, fingers?) *

Yes

No

Do you feel very stressed often? *

Yes

No

Do you have anxiety? *

Yes

No

Do you have depression? *

Yes

No

Do you feel cold often? *

Yes

No

Have your thyroid labs ever been not optimal? *

Yes

No

Have you ever had elevated thyroid antibodies? *

Yes

No

First Name

Last Name *

Email *

Phone *

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