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A few questions to further customize your experience

Your Health

All fields with (*) are required.


  1. Do you (or a loved one) have any of the following conditions?*
  2. Do you have medicare?*

Tell Us More About You

  1. Have you or a loved one been diagnosed with a skin condition called Psoriasis?*
  2. Do you or a loved one have Schizophrenia or other serious mental disorder?*
  3. Have you or a loved one been diagnosed with High Blood Pressure/Hypertension?*
  4. Have you or a loved one been diagnosed with cancer?*
  5. Do you or a loved one have Heartburn, GERD, or Acid Reflux?*
  6. Do you or a loved one have Atopic Dermatitis or Chronic Eczema?*
  7. Have you or a loved one been diagnosed or are suffering with Fibromyalgia?*
  8. Have you been diagnosed with hypothyroidism?*
  9. Have you been diagnosed with Overactive Bladder?*
  10. Are you a homeowner?*
  11. Have you or a loved one been injured in a car accident within the last 3 years?*
  12. Are you 40 years old or older?*

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