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Women’s Intake Questionnaire

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    Tell Us About Your Symptoms

    I experience hot flashes or night sweatsMy period is irregularI am experiencing moodiness or anxietyI have difficulty sleepingI am experiencing fatigueI am having difficulty losing weightI am experiencing brain fogI have muscle weaknessI experience diarrhea or constipationI am experiencing bloatingI am experiencing muscle achesI am experiencing low libidoI am experiencing hair lossI have tested positive for EBV or lymeI struggle with an autoimmune disorderI struggle with inflammation

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