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Full Name
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Email
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Phone
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What is the biggest challenge you are facing with your health currently? (Select all that apply)
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Irregular Periods
Weight Loss
Fatigue & Low Energy
Gut Issues (Constipation, bloating, acid reflux, IBS etc)
Hair Loss or Acne
Mood Swings or Anxiety
Infertility
Sugar Cravings
Thyroid
Hashimotos
Endometriosis
Scanty Periods
PCOS
Peri Menopause or Menopause
Other
What treatments have you tried so far? (Select all that apply)
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Birth Control Pills
Metformin/Other Medications
Diet Changes
Exercise
Ayurvedic Natural Remedies
IVF
Haven't tried anything yet
Is working on your health a priority for you?
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Yes, I want to start as soon as possible (7-15 days)
No, I will do it later
Are you willing to invest in your health? (30K INR for 3 months)
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Yes, I'm in!
No, not interested
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