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* 1. Is this your before or after survey

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* 2. Which Biomiq product did you purchase?

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* 3. How regularly did you take the product?

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* 4. On a scale of 1-10 (1 = Very Poor, 10 = Excellent) how would you describe your general health over the past 4 weeks?

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* 5. On a scale of 1-10 (1 = Very Poor, 10 = Excellent) how would you describe your energy levels over the past 4 weeks?

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i We adjusted the number you entered based on the slider’s scale.

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* 6. On a scale of 1-10 (1 = None, 10 = Severe) please indicate the level of discomfort or inconvenience you have experienced over the past 4 weeks, as a result of pain in your abdomen

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i We adjusted the number you entered based on the slider’s scale.

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* 7. On a scale of 1-10 (1 = None, 10 = Severe) please indicate the level of discomfort or inconvenience you have experienced over the past 4 weeks, as a result of constipation

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i We adjusted the number you entered based on the slider’s scale.

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* 8. On a scale of 1-10 (1 = None, 10 = Severe) please indicate the level of discomfort or inconvenience you have experienced over the past 4 weeks, as a result of bloating.

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i We adjusted the number you entered based on the slider’s scale.

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* 9. On a scale of 1 - 10 (1 = None, 10 = Very Regularly) how regularly did you suffer from bloating as a result of eating products with gluten in the last 4 weeks (bread, pasta etc)?

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i We adjusted the number you entered based on the slider’s scale.

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* 10. On a scale of 1-10 (1 = None, 10 = Severe) please indicate the level of discomfort or inconvenience you have experienced over the past 4 weeks, as a result of diarrhea.

1 10
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i We adjusted the number you entered based on the slider’s scale.

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* 11. On a scale of 1-10 (1 = None, 10 = Severe) please indicate the level of discomfort or inconvenience you have experienced over the past 4 weeks, as a result of muscle pain or fatigue.

1 10
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i We adjusted the number you entered based on the slider’s scale.

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* 12. On a scale of 1-10 (1 = None, 10 = Severe) please indicate the level of discomfort or inconvenience you have experienced over the past 4 weeks, as a result of joint pain or limited joint movement.

1 10
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i We adjusted the number you entered based on the slider’s scale.

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* 13. Please indicate your age

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* 14. Please indicate your gender

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* 15. We don't ask for your name on the survey. So we can match your before and after, please answer a memorable question.

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