24BGCFA01- Bragg Liquid

1

Do we have your consent to ask you some questions related to your lifestyle and medical history and to contact you regarding this study? (If you answer No, this survey will end). If you answer NO, this survey will end.

YESNO

2

Your Privacy Is Important to Us

We want to ensure the data we collect can be verified by researchers and send updates on the study should you qualify to participate. All information recorded will be maintained with the strictest confidentiality except as required by law. For more information, please review our Privacy Policy

3

Name

First Name

Last Name

4

Email

example@example.com

5

Phone Number

Please enter a valid phone number.

6

Postal Code

7

Will you be able to commit to answer all requested online questionnaires to study completion?

YESNO

8

What was your assigned sex at birth?

Male

Female

9

Are you presently pregnant, planning to become pregnant or presently breastfeeding?

YESNO

10

Please Enter Your Date of Birth

Date

11

What is your current height?

Height Number

Height Metric

12

What is your current weight?

Weight Number

Weight Metric

13

Has your doctor told you that your blood sugar is elevated?

YESNO

14

Have you been diagnosed as pre-diabetic in the past?

YESNO

15

Have you been told that you have metabolic syndrome?

YESNO

16

Have you had any significant(>5% of your body weight) weight changes in the past 3 months?

YESNO

17

When you get your blood taken, do they have issues taking the blood?

YESNO

18

If Yes, do you have problematic veins to find?

YESNO

19

Have you had a history of alcohol or illicit drug abuse, known drug dependence, or are seeking or have sought treatment for alcohol or substance abuse related disorders within the past 12 months?

YESNO

20

On average, how many standard alcoholic drinks do you consume per day?

None

Two or Less

3-5

6 or More

22

Do you use tobacco or nicotine products (e.g., cigarettes, vapes, e-cigarettes)?

I currently smoke.

No, I no longer smoke.

I have never smoked.

23

When was the last time you used tobacco or nicotine products?Please provide a date to the best of your ability.

24

Do you have a prescription for the use of cannabis products?

YESNO

25

Do you use recreational cannabis?

YESNO

26

How often do you use recreational cannabis?

Daily or 5-7+ times per week

Regularly or 3-4 times per week

Weekly or 1-2 times per week

Monthly or 1-3 times per month

Occasionally / less than once per month

28

Would you be willing to refrain from cannabis during the study?

YESNO

29

Do you have an food allergies or sensitivities?

YESNO

30

Please list your allergies or food sensitives.

31

Have you had a major surgery in the past 3 months or plan to have surgery in the next 3 months?

YESNO

32

What type of surgery was/is it?

34

If other, please indicate you condition.

35

Did you select kidney issues because you have/had kidney stones?

YESNO

36

Have you been symptoms free for the past 6 months?

YESNO

37

Have you had a significant cardiovascular events in the past 6 months?

YESNO

38

Is your medical condition currently in stable condition (have been treated for at least 3 months with no changes in medications), that is, you are being followed by a physician and taking prescribed medication to control their condition?

YESNO

39

Are you taking medications to control your condition?

YESNO

40

How long have you been taking your medications

1-2 months

3-5 months

Over 6 months

Over 1 year

41

Have you had/been diagnosed with cancer in the past 5 years or are you currently receiving chemotherapy or radiation?This does not include skin cancer (basal cell carcinoma) that has been fully excised without chemotherapy or radiation.

YESNO

42

Have you donated blood in the last 30 days or plan to in the next 30 days post?

YESNO

43

Please indicate which, if any, of the following prescription medications you take:

Steroid

Diuretics

Insulin Sensitizers

Metformin

GLP-1 Agonists (e.g., Ozempic, Saxenda, Victoza)

44

Do you use any other prescription medication daily?

YESNO

45

Please list your medications.

46

Do you use any of the following over-the-counter medications or supplements?

Decongestants (Ephedrine, Pseudoephedrine)

Supplements containing Vinegar

Glucosamine

Biotin

Supplements used to improve glycemic control (Alpha lipoic acid, chromium, berberine, aloe vera, ginger, cinnamon)

47

How long have you been taking them?

48

Do you use any over-the-counter medication or natural health products regularly?

YESNO

49

Please list below:

50

Will you be willing to maintain your current lifestyle habits throughout the study, including diet, medications, supplements, sleep, exercise and avoid taking any new supplements?

YESNO

51

Have you participated in a clinical trial within the last 30 days?

YESNO

52

Please enter the date the clinical trial participation ended?DD/MM/YYYY

54

Please describe where you heard about that study.

55

Please provide contact information for the person who referred you so we can thank them. Name & Email

56

Why did you decide to apply for participation in this study?

Interest in the topic being studied

Compensation being offered for participation

Have participated in clinical trial before.

Other

57

What was the other reason you decided to apply?

58

I consent to receiving communications from KGK Science Inc. and their third-party service providers (via electronic mail, electronic message, telecommunication, and automatic dialing-announcing device including the use of pre-recorded or synthesized voice messages). Your information will not be shared with and/or sold to external companies and is only used for communications with KGK Science.

YESNO