Full Name
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Email
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Phone
On a scale of 1-10 where is your energy level?
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How often do you feel anxious or overwhelmed in your days?
All of the time
More than I would like
Very rarely
Never
Do you have trouble with overindulging at meals? Could you use help with hunger control and appetite support?
Do you struggle with any of the following bathroom issues?
Constipation
Having BM's too often
Bloating
All of the above?
No issues, pretty regular
Could you benefit from extra support with Energy/ Focus/ Stamina?
Yes, everyday
Some days
Rarely
Do you feel bloated and puffy?
Do you often feel tired after lunch?