* 1. Address

* 2. Please list your age and the ages of your children, if applicable.  Also list the ages of your children when you began eating a real-food diet?

* 3. Do you consume cod liver oil?

* 4. Do you consume raw dairy? If so please list all that you do consume.

* 5. Do you eat pastured meats?

* 6. Do you consume fermented (cultured) drinks, vegetables and/or dairy?  If yes, please check all that apply.

* 7. Do you consume bone broth?  If so, check all that apply below.

* 8. What type of fats do you use to cook with and/or consume?

* 9. With what frequency do you consume organic produce?

* 10. Please list any/all ailments that have improved due to your diet choices.

* 11. Tell us your story in two - four paragraphs.  Begin with how you became aware of the principles of ancestral diets for nutrition. Please be as specific in your story as possible, including any ailments that have improved in your family and what you attribute those improvements to, or give one example of how you have overcome a challenge.  This should be your story, your perspective.  We believe it to be most valuable if you write based on what you believe are the most important aspects of your journey. 

* 12. Will you email us a picture at growingsuccessstories@gmail.com?  If so, please include your name and contact information in the email.

* 13. Do you give us permission to publish your story as long as no contact details are included?  (We still want your story for our research even if you do not want it published.)

* 14. Have you read and agree to the terms of the confidentiality agreement?  The confidentiality agreement can be found on our website here.

* 15. Have you read our disclaimer as posted on our website and do you agree to the terms?  The disclaimer can be found here.

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