Name
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Phone Number
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Email Address
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Address
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City, State, Zip
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Do you suffer from hypoglycemia, type II diabetes or PCOS?
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Do you suffer faintness, dizziness, cold sweats, shakiness or weak spells?
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Are you drowsy, especially after meals or in mid-afternoon?
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Are you over-emotional, crying spells?
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Do you have a rapid pulse, especially after eating certain foods?
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Are you frequently not hungry in the morning and often skip morning meals?
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Do you suffer from mental confusion or from needless worrying?
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Do you have cravings for starch and sugar-rich foods?
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Are you more than 30 pounds overweight?
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Difficulty losing weight even when exercising and cutting back on foods?
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