1. Do you have recurring skin issues like eczema,psoriasis or dry, flaky skin? *

Yes

No

2. Do you frequently experience joint pain, stiffness or symptoms resembling arthritis? *

Yes

No

3. Do you often feel fatigued, experience mood swings, or struggle with anxiety or low mood? *

Yes

No

4. Do you eat fatty fish salmon, mackerel, sardines) LESS than 3x per week? *

Yes

No

6. Do you use vegetable oil weekly in your cooking (corn, canola, sunflower, safflower, corn, vegetable)? *

Yes

No

5. Do you consume any fast foods weekly? *

Yes

No

7. Do you experience frequent digestive issues, such as bloating or IBS-like symptoms? *

Yes

No

8. Have you been diagnosed with or suspect high cholesterol, high blood pressure or insulin resistance? *

Yes

No

9. Do you frequently eat packaged crackers, chips, cookies? *

Yes

No

10. Do you eat peanut butter or processed foods weekly?

Yes

No

First Name *

Last Name *

Phone *

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Email *

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