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Check your Gut Health!

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Question 1 of 11

Do you experience any of the following symptoms regularly or somewhat regularly?

(Select all that apply)
A

Abdominal Pain or Discomfort

B

Bloating

C

Brain Fog

D

Insomnia

E

Joint Pain

F

Constipation

G

Diarrhea

H

Lump in Throat Feeling

I

Reflux

J

None of the Above

Question 2 of 11

What about these symptoms? Do you experience any of these symptoms regularly or somewhat regularly?

(Select all that apply)
A

Dry Skin

B

Fatigue

C

Hair Loss

D

Depression or Anxiety

E

Palpitations

F

Skin Breakouts

G

None of the above

H

Weight Gain

Question 3 of 11

How long have you noticed these symptoms?

Question 4 of 11

Do you take medication or supplements regularly? If so, please list them.

Question 5 of 11

Are you tired when you wake up or notice that you "crash" throughout the day?

A

Yes

B

No

Question 6 of 11

On average, how many hours of sleep do you get?

Question 7 of 11

On a scale from 1 to 10, how would you rate your stress levels day to day?

Question 8 of 11

Describe your typical diet or what you eat day to day.

Question 9 of 11

Do you experience any of these symptoms regularly or somewhat regularly?

(Select all that apply)
A

Hot Flashes

B

Irregular Menstrual Cycles (in length or duration)

C

PMS

D

N/A or None of the above

Question 10 of 11

What's your top health priority? (choose one)

A

Improving my digestion

B

Improving my immunity

C

Better Mood

D

Better Skin

E

Weight Management/Fitness

Question 11 of 11

Are you READY and WILLING to get to the root cause of your symptoms so you can have less pain, have more energy, be more productive and redesign your future?!

A

YES absolutely! I'd love to learn how!

B

Not sure..but I'd love to learn more information!

C

Not at this time

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