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* 1. What is your Name and Surname?

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* 2. Which Renewal Institute branch do you visit most often?

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* 3. If you would like us to update your e-mail address on our client database, please fill in your current e-mail address below?

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* 4. Please select your gender?

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* 5. Please select your age group:

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* 6. Do you struggle with chronic pain, or bothersome muscle spasms and joint inflammation?

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* 7. Do you have any of the below conditions: Chronic Fatigue, Fibromyalgia, Inflammation, Sports injuries, whiplash, Fever Blisters, Colds and Flu, Back Pain or Sciatica?

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* 8. Have you been receiving treatment for any of these conditions ?

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* 9. Did you know: There is a cost-effective, herbal and natural injection therapy that can alleviate pain associated with these conditions?

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* 10. Did you know: Biopuncture not only alleviates symptoms of pain, but helps your body heal itself through activating internal processes such as increased blood circulation, tissue repair, local muscle relaxation and local detoxification. 

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* 11. What treatment has helped you with pain relief?

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* 12. What is the reason for your chronic pain?

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* 13. Do you take any supplements to support healthy point and muscles, such as omegas and a multi-vitamin daily? 

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* 14. Are you currently overweight? Carrying excess weight can add strain to your body and increase pain.

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* 15. Do you get 6-8 hours of uninterrupted sleep each night? Good quality sleep helps your body recharge and heal.

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* 16. Would you like a Renewal Institute staff member to contact you to discuss the survey?

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