Hey Facebook! Fill out this quick questionnaire to book your free 15 minute consult!

Name *

First Name

Last Name

Thyroid Questionnaire *

Do you have cold hands / feet or intolerance to cold?

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Are you tired when waking up in the morning?

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Are you gaining weight or having trouble losing it?

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Do You feel slower or foggy brain?

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Do you have decreased vitality?

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree