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A few questions to further customize your experience

Your Health

All fields with (*) are required.

  1. Do you (or a loved one) have any of the following conditions?*
  2. Do you have medicare?*

Tell Us More About You

  1. Do you or the person you're caring for have grass allergies and want to receive information about a treatment option?*
  2. Have you had any minor or major surgeries over the last year?*
  3. Have you or a loved one been diagnosed with cancer?*
  4. Do you or a loved one suffer from Psoriasis?*
  5. Do you or a loved one struggle with ADD or ADHD?*
  6. Do you currently have dental coverage?*
  7. Do you suffer from eczema?*
  8. Have you been diagnosed with hepatitis C?*
  9. Have you or a loved one been diagnosed or are suffering with Fibromyalgia?*
  10. Are you 40 years old or older?*

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