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1 / 27

How familiar are you with how nutrient deficiencies and hormonal imbalance like high cortisol, also known as stress hormone might affect your mood, skin and weight?

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2 / 27

Are you experiencing skin changes like thinning, easy bruising, acne, or unusual face hair growth?

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3 / 27

Do you feel fatigued or have difficulty concentrating, often described as “brain fog”?

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4 / 27

Have you noticed an unexplained weight gain, especially around your belly?

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5 / 27

After eating a full meal, do you still feel unusually hungry?

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6 / 27

Despite efforts, do you find it challenging to lose weight?

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7 / 27

What is your height?

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8 / 27

What is your current weight?

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9 / 27

What is your desired weight?

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10 / 27

What is your age?

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11 / 27

How do you typically spend your day?

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12 / 27

When was the last time you were content with your body weight?

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13 / 27

When was the last time you were content with your skin?

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14 / 27

What skin conditions do you have?

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15 / 27

Do you workout?

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16 / 27

How tired do you typically feel during the day?

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17 / 27

Have you or your family members been diagnosed with hormonal imbalances or conditions like PCOS?

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18 / 27

Have you noticed an increase in thirst and frequency of urination?

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19 / 27

Do you suffer from frequent headaches?

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20 / 27

Does your face appear rounded or puffier than usual, often referred to as a “moon face”?

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21 / 27

Do you frequently experience muscle weakness, especially in your thighs and upper arms?

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22 / 27

How much do you usually sleep?

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23 / 27

How much water do you drink daily?

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24 / 27

Do you need help with any of the following issues?

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25 / 27

what is your name?*

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26 / 27

What is your phone number to discuss your nutrients and hormones balancing plan?*

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27 / 27

Where should we send additional information about hormones and nutrients deficiencies, stress release and weight loss?*

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