FREE Plexus Slim Sample!
Full Name
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First Name
Last Name
Address
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Street Address
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
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Benin
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Bhutan
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Bosnia and Herzegovina
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Canada
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Central African Republic
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Chile
China
Christmas Island
Cocos (Keeling) Islands
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Cote d'Ivoire
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Cyprus
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Democratic Republic of the Congo
Denmark
Djibouti
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Dominican Republic
Ecuador
Egypt
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Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
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Guinea
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Haiti
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Hong Kong
Hungary
Iceland
India
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Iran
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Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Laos
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Liberia
Libya
Liechtenstein
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Madagascar
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Maldives
Mali
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Mayotte
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Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
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Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
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Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
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Singapore
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Slovenia
Solomon Islands
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South Africa
South Ossetia
South Sudan
Spain
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Sudan
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eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
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Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
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Uruguay
Uzbekistan
Vanuatu
Vatican City
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Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
E-mail
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Phone Number
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Area Code
Phone Number
Are you currently a Plexus
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Customer
Preferred Customer
Ambassador
None of the above
Weight
*
Height feet
*
Height inches
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Desired Weight Goal
*
Timeline to reach weight
*
If you feel you are overweight - When or how did you gain your weight?
*
I put on a little weight at a time, over a long period of time.
I have had excess weight for a long period of time.
I put on weight in a "short period of time" or during an event - such as : on hormones, steroids, during pregnancy, during a stressful time, etc.
How many times have you lost wieght only to regain it back in a short period?
*
Once
Too many to count!
Twice
Never
Are you Diabetic, Pre-diabetic or have other sugar level issues such as Hypoglycemia? (or family history)
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Yes
No
Family history
Do you have High Cholesterol?
*
Yes
No
Family history
Do you have high blood pressure?
*
Yes
No
Family history
Do you eat three meals a day?
*
Yes
No
How much water (in ounces) do you drink a day?
*
Do you crave any of these? Ck all that apply.
*
Sugar/sweets
Carbs
Sodas or Diet Sodas
None
Do you have any of these digestive disorders?
*
IBS (Irritable Bowel Syndrome)
Constipation
Other
None
Do you suffer from any of these? Ck all that apply.
*
Brain Fog
Unexplained Fatigue
Bloating
Anxiety
Recurring Irritability
Heartburn
Indigestion
Lethargy
Food Allergies
Acne
Dry, Flaky, Itchy Skin
Jock Itch
Migraine Headaches
Environmental Allergies
Other
None
Do you suffer from any of the following Chronic pain, Auto-immune disorders or other aliments? Ck all that apple.
*
Fibromyalgia
Arthritis
Carpal Tunnel
Neck, Back, Shoulder, Arm Wrists, etc with numbness or tingling
Crohn's Disease
MS-Multiple Sclerosis
ADD, ADHD, Aspergers, Autism or other Autisic Spectrum Disorders
Neuropathy
Other
None
FIRST THING IN THE MORNING Spit into a glass of water and let it sit on the counter for a bit - minimun 15 minutes. What was the result?
Spit remained floating in a nice, cohesive "blob"
Spit began develop long strand-like tendrils dissolve down into the water (like jellyfish tentacles).
Spit spread out over the surface of the water.
Spit dissolved/dissipated in water
Spit sinks to the bottom of the glass.
To see if you might have Candida and need ProBio5, check all that apply.
*
Have you taken repeated or prolonged courses of antibacterial drugs (antibiotics)?
Have you been bothered by recurrent vaginal, prostate or urinary infections?
Do you feel "sick all over," yet the cause hasn't been found?
Are you bothered by hormone disturbances, including PMS, menstrual irregularities, sexual dysfunction, sugar cravings, low body temperature or fatigue?
Are you unusually sensitive to tobacco smoke, perfumes, cologns and other chemical odors?
Are you bothered by memory or concentration problems? Do you feel spaced out?
Have you taken prolonged courses of prednisone or other steroids; or have you taken "the pill" for 3 yrs or more?
Do some foods disagree with you or trigger your symptoms?
Does your skin itch, tingle or burn; or is it unusually dry; or are you bothered by rashes?
Check the interest level you are at today.
*
READY TO ORDER TODAY!
Very Interested
Still thinking about it
Very little interest
not interested
If I could show you a way to get your product for free the very first month, would you be interested?
*
ABSOLUTELY
Not a chance
Possibly...what would I have to do?
Do you agree to try the sample as soon as you receive it, then contact me that day to let me know what you thought of it?
*
Yes
No
Yes, in a few days
Questions?
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