1. What is your name? (We will print your name on your customized supplements)^*

2. How old are you?^*

3. Are you biologically male or female?^*

4. Are you currently taking any medication for chronic diseases? If yes, please specify^*

5. BMI: Please provide your height and weight.^*

6. What is your average blood pressure range?^*

7. What aspects of your health are you looking to improve? (Select all that apply)^*

8. To assess hormonal balance, please indicate if you experience any of the following symptoms:^*

9. Are you an active individual? (Select one)^*

10. How would you describe your sleep pattern? (Select one)^*