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Food Sensitivity Questionnaire
Please check all boxes below that apply to you at any time of your life
Food Allergies
(Required)
Ear Itching or Infections
Dark circles under eyes
Rashes, Eczema
Itchy Skin
Dry Skin
Joint Pain
Diarrhea
Brain Fog
Constipation
Abdominal Pain
Acne
Migrane Headaches
Bloating
Gas
Nose Bleeds
Asthma
Irritable/Inflammatory bowel
Acid reflux
Itchy eyes
Fatigue (2+ hrs after eating)
I do not remember ever experiencing any of these symptoms
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Email
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Email
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