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Name: *Mobile No: *Email: Question 1 – Do you have any health issues such as 3 highs (high blood pressure, high blood glucose, high blood liqid)? YesNo Question 2 – Do you have Stomach pain/Stomach ulcer? YesNo Question 3 – Do you have heart disease? YesNo Question 4 – If a product which can active your cells and you can feel it around 7 minutes, will you give it a try? YesNo I understand and agree to try at my best willingness.
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