Mobile Phone
*
Username
*
Make one that is easy short and easy to remember
4 Digit PIN
*
Choose a 4 digit number that can you easily remember
Age
Will help the study be more helpful
Zip Code
Will help the study be more helpful
Please check all that apply
I have one or more underlying medical conditions
I am an essential worker or returning worker
I am a frontline healthcare worker
I am self-isolating
I am using the Immunity Meal Plan for:
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Prevention
Treatment
May we contact you occasionally to see how you are doing on the meal plan?
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Yes, text me
Do not contact me
Other
Do you have someone who can report in or contact us if you are unable because of hospitalization or death?
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Yes
No
Did you write down or email yourself your Username and PIN in case you forget it
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Yes
No
Are you enrolling someone else because you are a caretaker?
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Yes
No
I have read the FDA Disclaimer and Warning at the bottom of this page and will contact my doctor to have them approve me to use the Immunity Meal Plan
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Yes
Please verify that you are human
*
Submit
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