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Health Assessments
Wellness Checkup
Hormone: Get Balanced
Detox: Get Clean
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Take this Hormones: Get Balanced assessment and receive feedback directly from me
1. What’s your name?
2. What is your email address?
3. What area of your health are you most concerned with or would you most like to improve?
4. What medical condition have you been diagnosed with by a physican? For example: PCOS, perimenopause, menopause or adrenal fatigue.
5. Your mood is:
A consistent mood with mental well being
At times I feel anxiety, depression or irritable
6. Your hair is:
Thinning or balding
Hair is growing on my face
No problems with hae thinning or facial hair
7. Your cycle is:
Regular with no PMS
Reuglar with PMS
Irregular with no PMS
Long heavy cycles
I do not have cycles
8. The following statement(s) applies to me:
Dry skin
Brain fog
Constipation
Infertility
Headaches
Hot flashes
Breast tenderness
Submit
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