Questionnaire

Understanding what is going on and what you have tried will have some insight in whether your DNA is getting turned on by lifestyle issues or supplements.

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Supplement Information

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Name: *

E-mail address: *

Are you currently taking supplements? List *

Have you ever been diagnosed with a chronic illness? List diagnosis and medication *

Did you ever any signs of anxiety/fears and/or depression/sadness? *

Anything you have been struggling with that seems easy for some but hard for you? *

Is there anything else that you need to say? *

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