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City
*
County / State / Province
*
Country
*
Name
*
First
Last
Age
*
Helpers Name: Lewis Rowlands
Phone Number
*
Date of last test
*
On a scale of 0-5 how well are you doing the following procedures?
Diet
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Supplements
*
Water
*
Lifestyle
*
Rest
*
Sauna or heatlamp
*
Spinal Twist
*
Foot Rubs
*
Coffee Enemas
*
Meditation
*
Skin Brushing
*
What supplements are you currently taking?
*
Medications?
Please write the question clearly and concisely in your own words. If there is more than one question, list them 1., 2., 3., etc.:
*
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