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PhotoTherapy : What's My Perfect Patch?
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What is your date of birth?
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Your complete mailing address:
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Best Phone # to reach you?
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How did you hear about Jennifer Waters, L.Ac. & Phototherapy Patches?
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Why would you like to try the Phototherapy patches?
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Are you trying to conceive naturally?
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Are you doing ART or IVF?
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Other:
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Are you looking to improve your egg quality?
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Are you preparing for an IVF transfer?
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Do you have any of the following?
Hot Flashes
Night sweats
Acne
PCOS
Headaches
Other:
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Do you have any of the following:
Circulatory problems including cold hands/feet
Tend to get cold easily
Low Ovarian Reserve
History of miscarriage
Digestive concerns including loose stools
Other:
Do you have any of the following?
"Hormone imbalance"
Food cravings
Sugar cravings
Hard time losing weight
Irregular periods
Other:
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Do you have any of the following?
PMS or PMS like symptoms
Irritability
Chronic stress
Excess weight in your abdomen
Systemic inflammation
Is there anything else you would like us to know about you?
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