Thyroid Survey

1

Please click all symptoms that you struggle with regularly* This field is required.

No energy

Anxiety

Gut / digestion

Brain Fog

Joint pain

Difficulty losing weight

Difficulty gaining weight

Feeling discontent / unhappy

Feeling stuck

Sugar / carb cravings

None of these

All of these

2

Please describe any other struggles not listed above.

3

Do you have a thyroid disease diagnosis? (Y/N) If Y, what kind?* This field is required.

4

Have you tried the Paleo diet to relieve your symptoms?* This field is required.

YESNO

5

If YES, how did you feel after trying Paleo?

6

Have you tried the Autoimmune Protocol to relieve your symptoms? * This field is required.

YESNO

7

If YES, how did you feel after trying the Autoimmune Protocol?

8

Are there any other diets, therapies, or protocols you have tried to help relieve your symptoms? (Y or N) And if Y, how did you feel after trying these?* This field is required.

9

Do you have any questions or comments for me? Thank you so much for your valuable feedback that teaches me how to better serve you!