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Online Health Appraisal Questionnaire

Thank you for your interest in taking our FREE online health appraisal questionnaire. This questionnaire is designed as a comprehensive health assessment which will help pinpoint specific areas of imbalance and provide you with specific recommendations to address any imbalances that are discovered.

You can take the entire questionnaire (it will take between 30-60 minutes, but you can do it in sections – your answers are automatically saved after you complete each section) or you can decide to take only the sections marked below – please tell us which sections you would like to take:

	Gastrointestinal health
	Liver/Gall bladder
	Thyroid
	Adrenal
	Blood sugar regulation
	Heart and Circulatory health
	Mood
	Immune system
	Kidney and Bladder
	Muscles and Skeletal health
	Central Nervous System and Brain Functionality
	Male Health
	Female Health
	Detoxification
	Entire Questionnaire

In order for you to take the online health appraisal questionnaire, we need to establish an account for you; please supply us with the following information:

First Name & Last Name:

E-mail Address:

ZIP Code:

Gender:
Male Female

Weight:

Age:

Pregnant?
Yes No

Comments (please include any diagnosed or suspected health conditions):

We will create a login account for you and email you the information you need to take the online health appraisal questionnaire.

Once you have completed the questionnaire, we will evaluate it and email you a report detailing the results and recommendations to help you address high priority areas determined from your answers to the online health appraisal questionnaire.

If you ever have any questions, please feel free to contact us.

Thank you for your interest in our products and services – we look forward to serving you along your natural path to optimal health.

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