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Child Neurotransmitter Nutrition Questionnaire

Find Your Weakest Link Fast

Give yourself the Most Important Support   and Supplements you are missing....

Complete our interactive online questionnaire and   receive our free personalized recommendations based on your Weakest links.

To compare your Health results before and after our suggested support, print any or all 3 of your FREE   Nutritional Assessment Forms and save them and see the difference in your health!

4 EASY STEPS

Step 1: Fill out and Submit the form.
Step 2: Your results are reviewed by our doctor; we will provide you with a personalized nutritional protocol.
Step 3: We contact you with your results during our regular business hours.
Step 4: Your order of the correct vitamins to support your weakest link will be Free shipping to you!
Optional
Step 5: Retake the test and see the improvements and continue improving

Fill out the forms now and start your FREE test for better health!

*Your privacy is of the utmost importance and none of the information we collect is never sold or shared with others. When you fill out the questions and send it to us, we must ask you for certain personal information so that we can provide your personalized results. We will use your email address to communicate any specials and other information designed to improve your experience and save out time and money with the MyVites.com site. At any time, you may unsubscribe by following the "unsubscribe" link in any such email, or by sending us an email request to remove your name from the list. The personal details collected during the evaluation process will not be shared or used in any other way.

Personal Information

Part I - Please check the appropriate number “0-3” on all questions below. 0 as the least/never to 3 as the most/always.

Please list your 5 major health concerns in your order of importance (one per line) :

GENERAL:

SECTION: A

SECTION: B

SECTION : D

SECTION : E

SECTION : F

SECTION: G

SECTION: H

SECTION: I

* Required Fields