Annique Forever Healthy Annique Forever Healthy Assessment Suitable For Ages 14 and Older Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Cell Phone NumberGenderMaleFemaleAgeBlood GroupHeight (in centimeters)Weight (Kilograms)MedicationSupplements OptiFloraIndigestionStomach discomfort / bloatingDiarrhoeaConstipationFood allergiesIrritable bowel syndromeAntibiotics in the last 3 monthsCandidiasis (thrush)OptiViteEasily get irritated / impatientFeel stressedEnergy less now than beforeLose concentration / mind goes blankDrink unfiltered waterEat inorganic food (bread, pasta, cake etc)Family history of cancer / diabetes / heart diseaseTaking any medicationOptiMegaHigh blood lipids - cholesterol, triglyceridesHigh blood pressureIrregular or rapid heart beatExcessive thirst or sweatingPoor memory or learning disorders (ADD, ADHD)Mood swings or depressionInflammatory problems - arthritis, asthmaDry skin / eczema / psoriasisOptiCalMagMuscle spasms / crampsJoint painTooth decay (fillings)InsomniaPoor memoryIrregular / rapid heartbeatHigh blood pressureAnxiety / nervousnessOptiCLack of energy / fatigueFrequent colds / infectionsBleeding or tender gumsEasy bruisingNose bleedsSlow wound healingRed pimples on skinPoor skin elasticityOptiToniQ+HyperacidityHeartburn / acid refluxMuscle crampsHigh or low blood pressureMuscle crampsHigh or low blood pressureGall / kidney stonesGout / arthritisAllergiesEczema / acneOptiRooibosFamily history of cancerFamily history of diabetesFamily history of heart diseaseSigns of premature agingDifficulty getting rid of infectionsHigh blood sugar / crave sugary foodsAllergiesStomach cramps / poor digestionAloe & Green Rooibos Health DrinkPoor / irregular bowel movementsStomach discomfort / bloatingConstipationSore throat / glandsHigh blood sugarFrequent colds / infectionsRed pimples on skinEnergy less now than beforeOptiCalmBloodshot, gritty eyes / eye painsFeel guilty when relaxingEasily get angry or irritablePoor memory / concentrationInsomniaTrying to get pregnantHeadaches / migrainesAnxiety, tension or depressionZerotoxWork in a polluted atmosphereDrive in heavy trafficDrink unfiltered waterSmokeDrink alcoholEat in restaurants or buy take-awaysEat inorganic foodDiarrhoeaCBD Isolate & Green RooibosHeadaches / migraines / body achesAnxiety, tension or depressionInflammatory problems - arthritis, asthmaDry skin / eczema / psoriasisHigh blood sugar / crave sugary foodsFamily history of heart diseaseFamily history of cancerFamily history of diabetesOptiDermDry, flaky skinHair lossSplit nails, white marks on nailsCracked lipsStretch marksPoor skin elasticityDull, oily hairEczema / dermatitisBone Broth Health DrinkPoor skin elasticitySuffer from eczema, psoriasis or rosaceaEye disorders - vision loss / glaucomaInflammatory problems - arthritis, joint painPoor gut health / irritable bowel syndromePoor nail, hair conditionFamily history of heart diseaseFrequent infectionsNAD & Green RooibosFamily history of AlzheimersFamily history of ParkinsonsFamily history of heart diseaseEnergy less now than before / fatiqueSigns of premature agingPoor memory / concentrationPoor muscle toneSkin condition: eczema, psoriasis or rosaceaSUPERFOOD: YellowInflammatory problems - arthritis, joint painPoor bowel functionDuodenal / gastric ulcersFamily history of cancerEye disorders: cataracts, macular degenerationHigh cholesterolPoor circulationPoor skin, hair or nail conditionSUPERFOOD: WhiteFrequent colds / infectionsUnable to clear infectionsFamily history of cancerHigh blood sugar levelsHigh cholesterol, triglyceridesHigh blood pressurePoor circulationHIVSubmit