Please provide the following information


Yes No
Do you use any of the following forms of hormonal contraception?
Have you ever suffered from hypertension or high blood pressure?
When it comes to vitamins and supplements, you are:
Do you currently take any supplements?
Where do you currently purchase your supplements?
Select all that apply
When it comes to traditional, Eastern Medicinal practices,like Ayurveda or TCM, you are:
In an average day, how often do you eat a portion of fruit or veggies?
In an average week, how often do you eat fish or seafood?
In an average week, how often do you eat red meat?
How would you describe your sugar habits?
How would you describe your overall diet?
Select all that apply
Are you allergic/choose not to consume any of the following?
Select all that apply
How many alcoholic beverages do you typically consume in a week ?
No judgement, we love a good drink too 😉 'One beverage = 1 shot/1 (250ml) glass'
Do you, or have you, regularly smoke(d)/vape(d)?
How often do you exercise?
Are you looking to support any of the following issues?
Which life moment are you looking to support?
(Select one)
Would you be interested in supporting any other health concerns?
(Choose up to 2 options)
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