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Little Leaf Collective

Name:
Do you have any specific health concerns? If yes, please specify.
Do you have any allergies? If yes, please specify.
Do you have any other dietary restrictions? If yes, please specify.
How would you rate your stress levels?
1
2
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10
Are you looking for a tea that aids digestion?
Yes
No
How many hours of sleep do you typically get per night?
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9
10
Do you experience any skin issues? If yes, please specify.
Which gastrointestinal issues do you commonly experience? (Select all that apply)
Bloating
Indigestion
Constipation
Diarrhea
On a scale of 1-10, how satisfied are you with your current weight?
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2
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6
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8
9
10
Do you have any specific weight loss goals? If yes, please specify.
How would you rate your ability to concentrate?
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8
9
10
Are you currently taking any medications or supplements? If yes, please specify.
How often do you experience breakouts or acne?
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9
10
We would love to email you your results. Please enter below :)
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