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Question 1 of 13
1. Question
Cold hands & feet
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Question 2 of 13
2. Question
hello
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<div class=”systems-que”>
<h4>Poor concentration or memory</h4>
<div class=”systems-ans”></div>
</div>
<div class=”systems-que”>
<h4>Cold hands & feet</h4>
<div class=”systems-ans”>{ [Never] [Occasionally] [Often] [Almost Always] }</div>
</div>
<div class=”systems-que”>
<h4>Frequent consumption of fried foods</h4>
<div class=”systems-ans”>{ [Never] [Occasionally] [Often] [Almost Always] }</div>
</div>
<div class=”systems-que”>
<h4>Smoker / Stressful or sedentary lifestyle</h4>
<div class=”systems-ans”>{ [Never] [Occasionally] [Often] [Almost Always] }</div>
</div>
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Question 3 of 13
3. Question
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Dry, brittle nails
Complexion or other skin issues
{ [Never] [Occasionally] [Often] [Almost Always] }Rashes, lesion or bruise easily
{ [Never] [Occasionally] [Often] [Almost Always] }Dry, brittle or thinning hair
{ [Never] [Occasionally] [Often] [Almost Always] }
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Question 4 of 13
4. Question
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Food allergies / difficulty digesting certain foods
Heavy coating on tongue
{ [Never] [Occasionally] [Often] [Almost Always] }Belching, gas or discomfort after meals
{ [Never] [Occasionally] [Often] [Almost Always] }Fewer than 2 bowel movements per day
{ [Never] [Occasionally] [Often] [Almost Always] }
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Question 5 of 13
5. Question
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Lack of energy or chronic fatigue
Exercise less than 2 times per week
{ [Never] [Occasionally] [Often] [Almost Always] }Swelling or inflammation
{ [Never] [Occasionally] [Often] [Almost Always] }Unexplained chronic issues (headache, skin, etc)
{ [Never] [Occasionally] [Often] [Almost Always] }
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Question 6 of 13
6. Question
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Stressful lifestyle or feeling drained
Express emotions in unhealthy ways
{ [Never] [Occasionally] [Often] [Almost Always] }Feeling irritable, anxious, moody or down
{ [Never] [Occasionally] [Often] [Almost Always] }Feeling that life has little or no purpose
{ [Never] [Occasionally] [Often] [Almost Always] }
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Question 7 of 13
7. Question
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Sore, painful or weak joints and bones
Brittle nails or hair
{ [Never] [Occasionally] [Often] [Almost Always] }Muscle cramps or spasms
{ [Never] [Occasionally] [Often] [Almost Always] }Diet high in meats, grains or caffeine
{ [Never] [Occasionally] [Often] [Almost Always] }
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Question 8 of 13
8. Question
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Crave or consume sweets, salty or junk foods
Monthly female issues or low sex drive
{ [Never] [Occasionally] [Often] [Almost Always] }Feeling irritable, anxious, moody or down
{ [Never] [Occasionally] [Often] [Almost Always] }Restless sleep or lack of sleep
{ [Never] [Occasionally] [Often] [Almost Always] }
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Question 9 of 13
9. Question
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Low sex drive
(Women) PMS or menstrual irregularities
{ [Never] [Occasionally] [Often] [Almost Always] }(Men) Impotence or prostrate issues
{ [Never] [Occasionally] [Often] [Almost Always] }Hot flashes, sweats, irregular body temperature
{ [Never] [Occasionally] [Often] [Almost Always] }
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Question 10 of 13
10. Question
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Smoker / regularly consume alcohol or caffeine
Tremors, muscle cramps or spasms
{ [Never] [Occasionally] [Often] [Almost Always] }Stressful lifestyle
{ [Never] [Occasionally] [Often] [Almost Always] }Numbess or tingling
{ [Never] [Occasionally] [Often] [Almost Always] }
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Question 11 of 13
11. Question
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Puffiness under eyes
Frequent or painful urination/urinary issues
{ [Never] [Occasionally] [Often] [Almost Always] }Diet high in meats and grains
{ [Never] [Occasionally] [Often] [Almost Always] }Sore, painful or weak joints/bones
{ [Never] [Occasionally] [Often] [Almost Always] }
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Question 12 of 13
12. Question
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Frequent illness (more than twice per year)
Frequent use of antibiotics
{ [Never] [Occasionally] [Often] [Almost Always] }Less than 3 servings of fruits & veggies per day
{ [Never] [Occasionally] [Often] [Almost Always] }Stressful lifestyle
{ [Never] [Occasionally] [Often] [Almost Always] }
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Question 13 of 13
13. Question
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Frequent illness (more than twice per year)
Exposure to air pollutants
{ [Never] [Occasionally] [Often] [Almost Always] }Puffiness under eyes
{ [Never] [Occasionally] [Often] [Almost Always] }Heavy mucus production or congestion
{ [Never] [Occasionally] [Often] [Almost Always] }
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