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Weight loss form
Do you have any medication or food allergies?
Are you pregnant or breastfeeding?
Have you ever been told that you have an electrolyte imbalance or other abnormal labs? (Please check all that apply)
Are you a diabetic?
Are you a smoker?
Do you use any recreational drugs?
Do you take Digoxin (Lanoxin) for a heart problem?
Do you take any diuretics or water pills?
Do you take any steroids, i.e. Prednisone?
Do you have any of the following conditions? (Please check all that apply)