"Welcome to the MOSSGOD Assessment Test!! Complete yours now to receive a call about your private membership!!"
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Step
1
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Name
*
First
Last
Phone
*
Email
*
Comment or Message
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Do you have menstrual pains or cramps?
Yes
No
Any issues with producing milk?
Yes
No
Are you pre-diabetic 1 or 2?
Yes
No
Any issues with muscle recovery before and/or after gym?
Yes
No
Are you dealing with iodine deficiency?
Yes
No
Do you currently have any issues with thyroid dysfunctions such as hyperthyroidism, hypothyroidism, and/or goiter development?
Yes
No
Are you dealing with depression?
Yes
No
Any issues with fever, coughs, cramps, jaundice and/or headaches?
Yes
No
Any issues with pain or inflammation within nasal passage or respiratory tract (nose, lungs, throat)?
Yes
No
Are you dealing with any chronic skin conditions such as eczema, psoriasis, acne etc?
Yes
No
Are you experiencing gastrointestinal issues such as swollen intestines (colitis), diarrhea, stomach pains?
Yes
No
Do you have type 1 or 2 Diabetes?
Yes
No
Are you experiencing anxiety and/or mood disorders?
Yes
No
Are you having issues with sleep?
Yes
No
Do you have asthma or breathing issues?
Yes
No
Are you experiencing strep, low moods, lack of motivation?
Yes
No
Are you experiencing memory loss?
Yes
No
Are you dealing with brain or heart issues?
Yes
No
Do you often have colds of flu-like symptoms?
Yes
No
Are you experiencing hair loss?
Yes
No
Are you dealing with pain in breast?
Yes
No
Do you have high cholesterol?
Yes
No
Any kidney issues?
Yes
No
Are you experiencing any urinary tract infections?
Yes
No
Have you experienced heart failure or irregular heartbeat?
Yes
No
Any sexual problems such as low libido, low sex drive, and/or low mental stamina?
Yes
No
Do you have high blood pressure?
Yes
No
Are you experiencing any bacterial infections?
Yes
No
Are you experiencing menopause, hot flashes?
Yes
No
Do you have an eating disorder?
Yes
No
Are you experiencing worm infestations in intestines or/and stomach?
Yes
No
Are you experiencing joint pain?
Yes
No
Are you dealing with arthritis?
Yes
No
Any tumors in the past and/or present?
Yes
No
Are you low in iron and/or potassium?
Yes
No
Are you experiencing loss of appetite, upset stomach?
Yes
No
Do you have gallbladder disease and/or intestinal spasms?
Yes
No
Do you drink alcohol excessively, liver disease?
Yes
No
Are you experiencing whooping cough, pneumonia, tuberculosis?
Yes
No
Are you dealing with gastrointestinal bleeding and/or diarrhea?
Yes
No
Having issues using bathroom?
Yes
No
Do you have any warts?
Yes
No
Dealing with arthritis and/or diabetes?
Yes
No
Currently dealing with prostate cancer?
Yes
No
Are you experiencing cardiovascular issues, blood clots?
Yes
No
Are you experiencing stomach issues?
Yes
No
Are you experiencing skin irritations and/or itching?
Yes
No
Choose symptoms you are facing from below options
Skin health
Low cell count
Weak immune system
Weak digestive system
Excess mucus
Unbalanced body fluids
Thyroid function
Choose symptoms you are facing from below options
Kidney disorder
Urinary tract infections
Gastrointestinal tract disorders
Poor blood circulation
Choose symptoms you are facing from below options
Unbalanced flora of the vagina canal
Poor blood circulation
Low Estrogen
Issues with menopause
Are you having this symptom
Waste in colon
Choose symptoms you are facing from below options
Respiratory illness
Arthritis pain
Weight loss
Unbalanced blood
Choose symptoms you are facing from below options
Liver Issue
Low immunity
Cramps
Gas
Choose symptoms you are facing from below options
Low sex drive
No appetite for sex
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