INTAKE FORM FOR DNA RENEWAL
Welcome to the first step in reclaiming your health and improving your longevity with DNA RENEWAL SYSTEMS! Please answer the following questions to receive your initial suggestions from Stephanie Lodge. Your answers will assist her in what she can recommend to you via email to get your health back on track and your immunity improved.
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Email *
Name *
Do you take supplements of any kind? *
If yes, what do you feel you spend monthly on them?
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Are your currently in pain? *
Are you currently having a hard time falling asleep at night? *
Required
Are you currently dealing with ANY kind of addictions? *
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Do you have any cardiovascular or blood pressure concerns? *
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Are you extremely fatigued? *
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Are you managing any kind of autoimmune or immune system conditions? *
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Do you have any skin conditions like acne, psoriasis, etc.? *
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Do you have any hormone imbalance? *
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Do you feel depressed? *
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Do you have inflammation in your body? *
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Do you feel stressed? *
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Are you feeling like you're aging faster or your health is declining faster than you like in general? *
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Are you dealing with financial stress? *
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Are you stressed over any relationship(s)? *
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Do you currently meditate? *
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Do you believe your immune system or DNA could be  compromised by any form of Covid exposure (virus or vaccine)? *
Required
What other physical concerns do you have that haven't already been asked about? *
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