Micronutrient Test

Answer the following questions about yourself:

1.
Do you have problems of stress tolerance or are you experiencing depression without any known reason?
Yes
No
2.
Are you suffering from dementia or memory loss?
Yes
No
3.
Do you feel fatigued most of the time even when you have not done a lot of work or even after you have had enough rest?
Yes
No
4.
Are you experiencing night blindness?
Yes
No
5.
Dou you suffer from excessive bleeding?
Yes
No
6.
Are you experiencing muscle weakness and reduced body energy?
Yes
No
7.
Do you have less or no appetite?
Yes
No
8.
Do you experience hot flashes?
Yes
No
9.
Has your skin complexion changed?
Yes
No
10.
Do you experience acute anxiety?
Yes
No
Please answer all of the questions before continuing.

Please provide us with your contact information to email your test results.

First Name:
Last Name:
Phone:
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