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PLEASE NOTE: Answer the following questions with a click in the ‘box’ after the question if it applies, otherwise leave it blank! Should only one of three answers in one question apply to you, click in the box. Note that a copy of your answered questionnaire will automatically be emailed to my office.
SECTION‐C: NICTINAMIDE THERAPY
Do you have any of the following characteristics?
SECTION‐D: BRAIN ALLERGIES
SECTION‐E: GLUCOSE TOLERANCE CHECK
SECTION‐F: ESSENTIAL FATTY ACIDS (OMEGAS)
SECTION‐G: ENDOCRINE SYSTEM
SECTION‐H: GENERAL HEALTH
ALLOPATHIC MEDICATION (PRESCRIPTION)
SUPPLEMENTS (SELF MEDICATION)