NUTRITIONAL DEFICIENCIES SURVEY

Please tick everything that aplies under each vitamin and mineral. When you’re done, make sure you click submit so your answers are sent to me.

Vitamin A

Vitamin B1

Vitamin B2

Vitamin B3

Vitamin B5

Vitamin B6

Vitamin B12

Biotin

Vitamin C

Calcium

Chromium

Vitamin D

Vitamin E

Folic Acid

Iron

Vitamin K

Manganese

Omega 3 & 6

Potassium

Selenium

Zinc

10 + 7 =