Body Wellness Exam Quiz Name* First Last Email* Phone*I feel depressed or suffer from anxiety* Never Sometimes Often Always I suffer from memory loss or mental confusion* Never Sometimes Often Always I experience frequent mood changes or irritability* Never Sometimes Often Always I have a hard time sleeping or always feel fatigued* Never Sometimes Often Always I have frequent migraines or severe headaches* Never Sometimes Often Always I struggle with weight loss or unexplained weight gains* Never Sometimes Often Always I struggle with the desire to be intimate with my partner* Never Sometimes Often Always PhoneThis field is for validation purposes and should be left unchanged. x