Water-Soluble Vitamins Assessment
Evaluate your intake, awareness, and symptoms related to water-soluble vitamins to support your nutritional health.
Full Name
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First Name
Last Name
Age
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How often do you consume foods rich in water-soluble vitamins (such as fruits, vegetables, whole grains, or fortified cereals)?
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Daily
Several times a week
Rarely
Never
Other
Which water-soluble vitamins are you familiar with? (Select all that apply)
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Vitamin C (Ascorbic Acid)
Vitamin B1 (Thiamine)
Vitamin B2 (Riboflavin)
Vitamin B3 (Niacin)
Vitamin B6 (Pyridoxine)
Vitamin B12 (Cobalamin)
Folate (Vitamin B9)
Biotin (Vitamin B7)
Pantothenic Acid (Vitamin B5)
Other
Do you currently take any vitamin supplements?
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Yes
No
Have you experienced any of the following symptoms recently? (Select all that apply)
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Fatigue or weakness
Mouth sores or cracks at the corners of the mouth
Frequent infections or slow wound healing
Tingling or numbness in hands/feet
Skin rashes
None of the above
Other
Please share any additional comments or questions regarding your water-soluble vitamin intake or concerns.
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