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20
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This 3-minute questionnaire will help us build a Custom Pak unique to your needs and goals.
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What's your first name?
Paks will be customized with your name.
Required
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What's your first name?
Paks will be customized with your name.
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On an average day, you eat fruit and vegetables:
one serving is approximately fist-sized
Required
Rarely
Between 3 - 6
7 or more times
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On an average day, you eat lean protein:
eg. fish, chicken, turkey, plant-based protein, etc. one serving is approximately 3oz
Required
Between 0 - 2
3 or more times
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In an average week, how many alcoholic beverages?
Required
0 - 1
Between 2 - 5
6 or more
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Do you smoke or encounter second-hand smoke weekly?
Required
No
Yes
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Do you get less than 20 minutes of daily sun exposure?
Required
No
Yes
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How much time do you spend looking at screens?
Required
Not often
A few hours a day
I’m always on the computer/phone
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On average, how are your energy levels?
Required
I’m always exhausted
I usually have an energy slump
Pretty good
No complaints
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Are you experiencing a lot of stress?
Required
No
Yes
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How do you sleep?
Required
I sleep well
I don’t get enough sleep
My mind races when I’m trying to sleep
I have problems staying asleep
I don’t sleep well for another reason
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Have you taken antibiotics within the last year?
Required
No
Yes
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Do you have any digestive issues?
Required
None
SIBO
Heartburn or Indigestion
Gas or Bloating
IBS
Diarrhea
I have other digestive problems
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Do you experience joint or tendon pain?
Required
I have tendonitis
Only after hard exercise
My joints hurt all the time
No complaints
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How often do you feel sick?
Required
More than once a month
2-3 times per year
Hardly ever
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Are you exposed to toxic chemicals daily?
Such as a hair salon, mechanic or any place you may inhale toxic chemicals
Required
Yes
No
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Do you have any conditions related to heart health?
Required
None
High Blood Pressure
Congestive Heart Failure
High Cholesterol and I am taking statins
High Cholesterol and I am not taking statins
Angina
Atherosclerosis
High Triglycerides
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Do you have any conditions related to kidney and bladder health?
Required
None
History of Kidney Stones
Frequent Bladder Infections
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Do you have any conditions related to blood sugar and endocrine health?
Required
None
Diabetic Neuro or Retinopathy
High HbA1c/Prediabetes
Hypothyroidism
Generally high blood sugar levels
Type I Diabetes
Type II Diabetes
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