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What is your age?
What is your gender?
Do you take vitamin supplements?
If so, how many times a week do you take vitamin supplements?
How many servings of high fiber grains, such as bread, cereal, and rice do you eat per day?
How many servings of fruit do you eat per day?
How many servings of vegetables do you eat per day?
On average, how many times a week do you do aerobic exercise?
Do you have any pets?
Which describes your current marital status?
Have you ever had a heart attack?
Have you ever had a stroke?
Are you regularly exposed to urban pollution, second-hand smoke, excessive sunlight or other toxins?
What is your #1 health concern? (Choose one)
What is your #2 health concern? (Choose one)
What is your stress level on average?
Do you over eat or crave snacks between meals?
Are you currently under a physician"s care or taking any prescription medications?
For a customized nutritional recommendation, please provide your email address:
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