Skip to content
4 my health logo
Menu

Initial Questionnaire

(Make sure to fill out all the fields marked with an asterisk before completing the form)

1 = Not at all. 2 = Occasionally. 3 = Can do without it. 4 = Must have it daily. 5 = Constantly.
1 = Not at all. 2 = Occasionally. 3 = Can do without it. 4 = Must have it daily. 5 = Constantly.
This product is not intended to diagnose, treat, cure of prevent any disease.
If the form doesn't go through, double-check that you completed all the fields marked with an asterisk as they're required.