General Health Quiz Step 1 of 21 - Contact Information 4% Please let us know to whom and where to email your quiz results.First Name(Required) Last Name(Required) Email(Required) Phone(Required)State(Required)* Select State of ResidenceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificNewsletter Signup(Required)* Sign up for the Functional Kidney Care Newsletter? Yes, please No, thank you How Often Do You Feel Fatigued?(Required)* How Often Do You Feel Fatigued? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do You Feel Tired After a Full Night’s Sleep (8 or More Hours)?(Required)* How Often Do You Feel Tired After a Full Night’s Sleep (8 or More Hours)? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do You Have Insomnia?(Required)* How Often Do You Have Insomnia? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do Have Brain Fog?(Required)* How Often Do Have Brain Fog? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do You Have Headaches?(Required)* How Often Do You Have Headaches? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do You Get Dizzy When You Stand Up?(Required)* How Often Do You Get Dizzy When You Stand Up? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do You Have Aches and Pains?(Required)* How Often Do You Have Aches and Pains? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do You Have Anxiety?(Required)* How Often Do You Have Anxiety? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do You Feel Depressed?(Required)* How Often Do You Feel Depressed? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do You Crave Sweets?(Required)* How Often Do You Crave Sweets? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do Have Skin Problems?(Required)* How Often Do You Have Skin Problems (e.g. Acne, Hives, Rashes or Eczema)? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do Have GI Symptoms?(Required)* How Often Do You Have GI Symptoms (e.g. Heartburn, Acid Reflux (GERD), Belching, Indigestion or Bloating)? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do Have Constipation?(Required)* How Often Do Have Constipation? Frequently (2 or More Times / Week) Sometimes Rarely How Often Do Have Diarrhea?(Required)* How Often Do Have Diarrhea? Frequently (2 or More Times / Week) Sometimes Rarely Do You Have Trouble with Weight Gain / Losing Weight?(Required)* Do You Have Trouble with Weight Gain / Losing Weight? Yes No Do You Have History of Frequent Antibiotic Use?(Required)* Do You Have History of Frequent Antibiotic Use? Yes No Do You Have Recurrent Yeast Infections?(Required)* Do You Have Recurrent Yeast Infections? Yes No Do You Notice Any Sensitivity To Smells or Perfumes?(Required)* Do You Notice Any Sensitivity To Smells or Perfumes? Yes No Do You Have Frequent Cold or Sinus Infections?(Required)* Do You Have Frequent Cold or Sinus Infections? Yes No Do You Have Seasonal Allergies?(Required)* Do You Have Seasonal Allergies? Yes No * Required
