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21 Day Cleanse Questionaire

Complete this Questionaire to see if the 21-Day Cleanse is right for you!

Click the button below to start.

Start

Question 1 of 13

Do you get bloated after eating?

A

Yes

B

No

Question 2 of 13

Do you tend to gain weight easily, especially in your belly?

A

Yes

B

No

Question 3 of 13

Do you have extra pounds that won’t come off with diet and exercise?

A

Yes

B

No

Question 4 of 13

 

Do you have headaches more than occasionally?

A

Yes

B

No

Question 5 of 13

Do you frequently belch or feel gassy or gurgling in your belly?

A

Yes

B

No

Question 6 of 13

Do you tend to feel lethargic during the day?

A

Yes

B

No

Question 7 of 13

Do you have cravings for sugar or starchy foods?

A

Yes

B

No

Question 8 of 13

 

Do you experience mood swings or anxiety?

A

Yes

B

No

Question 9 of 13

 

Do you have difficulty focusing or experience a foggy brain?

A

Yes

B

No

Question 10 of 13

Do you have allergies or hayfever?

A

Yes

B

No

Question 11 of 13

Do you experience pain, muscle achiness, or stiffness in your joints?

A

Yes

B

No

Question 12 of 13

Do you feel addicted to foods that you know aren’t good for you... and yet you can’t stop?

A

Yes

B

No

Question 13 of 13

Do you feel anxious, upset, nervous, or downright cranky?

A

Yes

B

No

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