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Women's Health Questionnaire

Women Form Questionnaire

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Do you have weight gain in hips, thighs, buttocks?*
Do you experience foggy thinking?*
Are you experiencing premenstrual weight gain?*
Are you experiencing heavy/painful or irregular cycles?*
Do you have increased appetite/sugar carvings?*
Do you have a sluggish metabolism?*
Are you experiencing mood swings/premenstrual syndrome (PMS)?*
Name*

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Men's Health
Women's Health
Integrative Weight Loss