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* 1. What is your age range?

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* 2. How would you describe your current sleep schedule?

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* 3. What is your current mood?

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* 4. How would you describe your Libido? 

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* 5. How would you describe your energy levels? 

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* 6. How often do you exercise?

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* 7. Are you experiencing any hair loss currently?

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* 8. Where do you normally gain weight?

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* 9. How would you describe your ability to focus?

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