Select Gender *

Male

Female

I have been diagnosed with a thyroid condition (such as hypothyroidism, hyperthyroidism, Hashimotos, Graves or thyroid cancer). *

Never (No)

Sometimes (I don't know)

Always (Yes)

I have noticed changes in weight recently (Both Weight Gain or Weight Loss) *

Never (No)

Sometimes (I don't know)

Always (Yes)

I have swelling or lumps in my neck *

Never (No)

Sometimes (I don't know)

Always (Yes)

I am experiencing anxiety *

Never (No)

Sometimes (I don't know)

Always (Yes)

I have experienced difficulty concentrating (brainfog). *

Never (No)

Sometimes (I don't know)

Always (Yes)

I have noticed Heat/Cold Intolerance *

Never (No)

Sometimes (I don't know)

Always (Yes)

I experience constipation or loose stool *

Never (No)

Sometimes (I don't know)

Always (Yes)

I have noticed dry skin, dry hair, hair thinning/loss *

Never (No)

Sometimes (I don't know)

Always (Yes)

My blood labs come back normal but I know there must be something wrong *

Never (No)

Sometimes (I don't know)

Always (Yes)

The outer ⅓ of my eye brows are thinning *

Never (No)

Sometimes (I don't know)

Always (Yes)

I have noticed changes in my bowel movements (such as constipation or diarrhea) *

Never (No)

Sometimes (I don't know)

Always (Yes)

I have been exposed to radiation, either through medical treatments or environmental factors. *

Never (No)

Sometimes (I don't know)

Always (Yes)

I have a history of autoimmune diseases, such as rheumatoid arthritis or lupus. *

Never (No)

Sometimes (I don't know)

Always (Yes)

I have noticed changes in my voice or hoarseness. *

Never (No)

Sometimes (I don't know)

Always (Yes)

I have been under significant stress or changes in my life. *

Never (No)

Sometimes (I don't know)

Always (Yes)

I have had difficulty swallowing or a sensation of a lump in my throat. *

Never (No)

Sometimes (I don't know)

Always (Yes)

I am experiencing feelings of depression. *

Never (No)

Sometimes (I don't know)

Always (Yes)

I have dry/itchy skin. *

Never (No)

Sometimes (I don't know)

Always (Yes)

I’m always tired. *

Never (No)

Sometimes (I don't know)

Always (Yes)

Where can we send your results?

Last Name *

First Name *

Email *

Phone

UTM Source

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