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Health Survey
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Name:
Your answer
Email:
Your answer
If there is one thing you could change about your health today, what would it be?
Your answer
What are you hoping to achieve? Check all that apply
Energy and/or healthy alternatives to energy drinks
Weight Loss
Joint and ligament flexibility
Heart health
Respiratory health
Digestive health
Joint support
Foot and muscle maintenance
Healthy immune function
Skin health
Sleep quality
Other:
Other Health concerns:
Your answer
Do you take vitamins or herbals of any kind?
Yes
No
Clear selection
Do you take prescription medication?
Yes
No
Clear selection
Is there any reason why you would not be willing to use a product related to these concerns?
Your answer
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