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(Check all that apply) Chronic FatigueObesityAnxietyDepressionDigestion ProblemsFood IntolerancesDiabetesCold & InfluenzaIrritable Bowel SyndromeMusculoskeletal IssuesUlcerative ColitisCrohn’s Disease
(Check all that apply) High Blood PressureHigh CholesterolHeart Disease PreventionStress Management
(Check all that apply) Headaches/MigrainesInsomniaBrain FogFibromyalgiaMultiple Chemical SensitivityThyroid Disease
(Check all that apply) Slowing Metabolism & Weight GainHormonal ImbalanceMenopausal ConcernsPremenstrual Syndrome (PMS)InfertilityMood ImbalancesOsteoporosisAging
