PharmcoRx Smart Vitamin Program

Relax. Rejuvenate. Revitalize.

Hi there!

This evaluation is expected to last approximately 5 minutes. In this time, we'll pose several questions to understand you more thoroughly. Based on your responses, we'll assess if incorporating any vitamins, minerals, or supplements into your daily regimen could assist in achieving the objectives you've mentioned during this assessment.

Full Name

Date of birth

What sparked your interest in this analysis?

Just Curious

Been Interested in Vitamins for a While

Been Taking Supplements for a While

Is there anything specific on your mind in terms of health you'd like to focus on?

How often do you eat vegetables?

One or twice a week

2-3 times a week

4+ times a week

How often do you need fruits?

Once or twice a week

2-3 times a week

4+ times a week

How often do you eat dairy?

Hardly ever

Once or twice a week

3+ times a week

How often do you eat fish?

Hardly ever

Once or twice a week

3+ times a week

How often do you eat meat?

Hardly ever

Once or twice a week

3+ Times a week

Are you concerned about blood sugar levels?

Yes

No

How many cigarettes do you smoke per day?

Do you drink alcohol?

Yes

No

Are you concerned about your bone health/bone strenght?

Yes

No

Have you received test results indicating you have low vitamin D?

Yes

No

Do you live in a place where there is not a lot of sun or you spend most of your time indoors?

Yes

No

Do you have family history of issues with bone health?

Yes

No

Would you like support for your hair, skin, and nails?

Yes

No

Are you interested in increasing youthful, moisture, and elasticity to your skin?

Yes

No

Do you currently have dry or itchy skin?

Yes

No

Are you interested in preventing general aging of your skin?

Yes

No

Are you looking for general digestion support?

Yes

No

Do you experience bloating or have issues with gas?

Yes

No

Do you frequently have diarrhea?

Yes

No

Are you currently looking to maintain a healthy weight?

Yes

No

Do you participate in high-endurance cardiovascular activities more than 3 times a week?

Yes

No

Are you looking for muscle recovery support after exercise?

Yes

No

Phone *

Email *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Do you get OTC benefits through a Medicare Advantage plan?

Yes

No

info@pharmcorx.com

888-919-7411