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Autoimmune quiz
1
Are you experiencing obvious reactions to certain foods or after eating—gas, bloating, inflammation?
yes
no
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2
Are you intolerant to cold or heat, and/or do your hands or feet turn bluish?
yes
no
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3
Do you have a family history of autoimmune issues?
yes
no
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4
Do you have joint pain and swelling?
yes
no
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5
Do you have unexplained rashes or chronic acne?
yes
no
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6
Do you have extreme, constant, fatigue that cannot be relieved by sleeping?
yes
no
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7
What other symptoms do you have?
Fatigue
Brain fog
Poor energy
Constipation
Diarrhea
Brain fatigue
Joint pain that comes and goes
Muscle pain that comes and goes
Bloating after eating
Thinning hair
Thinning skin
Rapid heart rate
Rapid heart rate
Anxiety
Depression
Poor sleep
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8
Do any of the above symptoms come and go?
yes
no
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9
Your Score is {typeA}/280
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10
Are you looking for a new approach to your health?
*
This field is required.
Yes
No
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11
Where should we send the results?
example@example.com
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12
Name
First Name
Last Name
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13
Phone Number
*
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Area Code
Phone Number
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