Wondering if you should be on a vitamin and/or supplement regiment?

Health risks, diseases, medications and our lifestyle can deplete our bodies of essential vitamins and nutrients. Answer the questions below to help the clinical pharmacists at Solutions Pharmacy determine if you can benefit from vitamins and supplements. 

You will receive a call back in one business day. Our clinical pharmacist will ask you follow-up questions if needed and provide you recommendations and if you wish a Personalized Vitamin Bundle. 

Vitamin bundles can be purchased through Solutions Pharmacy and can be picked up, delivered or mailed to you monthly. 

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* 1. Phone number with area code

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* 2. What areas of health and wellness do you want to support with vitamins and supplements? Check all that apply. 

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* 3. Do you have environmental allergies

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* 4. Do you have food allergies?

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* 5. Have you been diagnosed with any of the following health risks or conditions? Check all that apply.

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* 6. Are you taking medication for any of the following health risks or conditions? Check all that apply.

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* 7. Do you experience any of the gastrointestinal symptoms listed below? Check all that apply.

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* 8. How often do you exercise?

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* 9. Do you follow any specific diets? Check all that apply.

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* 10. How many 1-cup servings of fruits and/or vegetables do you eat a day.

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* 11. How often do you eat calcium rich foods like yogurt, cheese, seeds, milk, fortified cereals, dark leafy greens? 

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* 12. How often do you eat fish or foods high in omega-3 fatty acids?

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* 13. How many 8 oz. cups of coffee or caffeine do you have a day? 

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* 14. How many hours of sleep do you usually get?

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* 15. How many alcoholic drinks do you have a week?

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* 16. Do you smoke, vape or use illicit drugs?

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* 17. Describe your sleeping habits over the last 6 months. Check all that apply.

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* 18. Please rate your energy level throughout the day.

  Low Medium High Tired but Wired
Morning
Noon
Afternoon
Evening
Bedtime

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* 19. Women only question. Check any of the symptoms below you are experiencing. 

0 of 19 answered
 

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