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Women’s Questionnaire
Men’s Questionnaire
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Women's form Questionnaire
Are you experiencing weight gain or bloating?
Yes
No
Are you experiencing night sweats or hot flashes
Yes
No
Are you experiencing brain fog or difficulty concentrating?
Yes
No
Are you experiencing premenstrual weight gain?
Yes
No
Are you experiencing heavy/painful or irregular cycles?
Yes
No
Do you have increased appetite/sugar carvings?
Yes
No
Do you have a sluggish metabolism?
Yes
No
Are you experiencing mood swings/premenstrual syndrome (PMS) ?
Yes
No
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