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First Name: * This Field is required This Field IS visible on profile
Middle Name: This Field IS visible on profile
Last Name: * This Field is required This Field IS visible on profile
Username: * This Field is required This Field IS visible on profile Information for: Username: : Please enter a valid User Name. No spaces, more than 2 characters and contain 0-9,a-z,A-Z
 
E-mail: * This Field is required This Field IS NOT visible on profile Information for: E-mail: : Please enter a valid e-mail address.
Password: * This Field is required This Field IS NOT visible on profile Information for: Password: : Please enter a valid Password. No spaces, more than 6 characters and contain 0-9,a-z,A-Z
Verify Password: * This Field is required This Field IS NOT visible on profile
Occupation: This Field IS visible on profile
Company: This Field IS visible on profile
City: This Field IS visible on profile
State: This Field IS visible on profile
Zip Code: This Field IS visible on profile
Country: This Field IS visible on profile
Address: This Field IS visible on profile
Phone #: This Field IS visible on profile
Fax #: This Field IS visible on profile
Are you currently seeing a doctor:
* This Field is required This Field IS visible on profile Information for: Are you currently seeing a doctor : Are you currently seeing a doctor about your health concerns?
When was your last health checkup:
* This Field is required This Field IS visible on profile Information for: When was your last health checkup : When did you last see a doctor for a health checkup?
What is your ethnic background:
* This Field is required This Field IS visible on profile Information for: What is your ethnic background : What is your ethnic background? (Various conditions affect certain groups more than others)
Level of pain tolerance:
* This Field is required This Field IS visible on profile Information for: Level of pain tolerance : What is your level of pain tolerance generally?
Do you suffer from arthitis or inflammation:
* This Field is required This Field IS visible on profile Information for: Do you suffer from arthitis or inflammation : Inflammation. Have you suffered from one or more inflammations that seem chronic or recurring?
Do you have diabetis:
* This Field is required This Field IS visible on profile Information for: Do you have diabetis : Do you suffer from diabetes?
Do you suffer from cardiovascular disease:
* This Field is required This Field IS visible on profile Information for: Do you suffer from cardiovascular disease : Do you suffer from cardiovascular disease? hypertension,irregular heart beat others please specify what type.
How easy do you find it to relax:
* This Field is required This Field IS visible on profile Information for: How easy do you find it to relax : How easy do you find it to relax?
Do you recover slowly from colds:
* This Field is required This Field IS visible on profile Information for: Do you recover slowly from colds : Do you tend to recover slowly from colds and / or feel weak afterwards?
Do you have digestive problems:
* This Field is required This Field IS visible on profile Information for: Do you have digestive problems : Do you suffer from digestive problems? hyper-acidity, gerd, ulcer, flatulence, belching and others
Is your stomach upset by greasy food:
* This Field is required This Field IS visible on profile Information for: Is your stomach upset by greasy food : Is your stomach upset by greasy food?
How much food with calcium:
* This Field is required This Field IS visible on profile Information for: How much food with calcium : Estimate how much food you consume that has been fortified with calcium. Common examples are orange juice, soy milk, milk and other dairy products.Do you take calcium supplements?
Consume iodine-containing food:
* This Field is required This Field IS visible on profile Information for: Consume iodine-containing food : Estimate how often you consume iodine-containing food. The most common dietary sources of iodine are seaweeds and iodized salt.
Consume processed meats:
* This Field is required This Field IS visible on profile Information for: Consume processed meats : Do you consume processed meats, such as hot dogs, sausages, bacon, jerky, smoked ham or luncheon meats?
Do you consume fast food:
* This Field is required This Field IS visible on profile Information for: Do you consume fast food : Do you consume fast food?
Consume deep-fried foods:
* This Field is required This Field IS visible on profile Information for: Consume deep-fried foods : Aside from fast food, how often do you consume deep-fried foods?
How often do you consume grilled:
* This Field is required This Field IS visible on profile Information for: How often do you consume grilled : Aside from fast food, roughly how often do you consume grilled, broiled or barbecued red meat or chicken?
How many fruits and vegetables do you eat:
* This Field is required This Field IS visible on profile Information for: How many fruits and vegetables do you eat : On average, how many DAILY servings of fruits and vegetables do you eat? A serving is about the size of a tennis ball, or half a cup (125ml) for most fruits and vegetables. Include everything except potatoes and grains such as rice.
How much dark leafy green do you eat:
* This Field is required This Field IS visible on profile Information for: How much dark leafy green do you eat : Approximately how much dark leafy green vegetable or broccoli do you eat? A serving is about the size of a tennis ball, or half a cup (125ml).
How often you eat sugar-containing snacks:
* This Field is required This Field IS visible on profile Information for: How often you eat sugar-containing snacks : Refined sugar. Estimate how often you consume sugar-containing snacks (cookies, candy bars...), desserts (cakes, puddings...) or other servings of at least one tablespoon of sugar (for example in cereal, coffee...)? Do not include soft drinks here.
Hydrogenated oils / fats:
* This Field is required This Field IS visible on profile Information for: Hydrogenated oils / fats : Hydrogenated oils / fats. How often, on average, do you consume them, not distinguishing good oil from bad? They are often found in margarines, cakes, biscuits, french fries, chips, and sweets for example.
What kind of oils do you consume daily?:
* This Field is required This Field IS visible on profile Information for: What kind of oils do you consume daily? : Estimate how much oil you're currently using ex. frying, vegetable oil,canola oil, olive oil or coconut oil you consume per week.Essential fatty acids include avocado oil, omega 3 from fish, nuts and other sources.
How much meat do you consume daily:
* This Field is required This Field IS visible on profile Information for: How much meat do you consume daily : Identify the percentage of your meat consumption daily from red meat(beef, pork, lamb, chicken others
How many servings of fish:
* This Field is required This Field IS visible on profile Information for: How many servings of fish : How many servings of fish do you consume on average per month?
Do you eat refined white flour products:
* This Field is required This Field IS visible on profile Information for: Do you eat refined white flour products : Do you eat refined white flour products, for example French, Italian or other white bread, bagels, pasta etc.?
How much added salt:
* This Field is required This Field IS visible on profile Information for: How much added salt : Salt. How much added salt (salt that is not already in the food) do you consume on average?
Rate your overall intake from supplements:
* This Field is required This Field IS visible on profile Information for: Rate your overall intake from supplements : How would you rate your overall intake from supplements?
When are you born: * This Field is required This Field IS visible on profile Information for: When are you born : When is your birthday?
What are your primary health concerns: * This Field is required This Field IS visible on profile Information for: What are your primary health concerns : What are your primary health concerns?
 
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