Magnesium Mini-Test Name* First Last Email* Select all that apply: Heart rhythm disturbances Rapid heart rate Chronic fatigue Muscles that tear or injure easily Muscle cramps or cramps in the bottom of the feet Night sweats Excessive body odor Muscle twitching Muscular tension or tight muscles Enlarged facial pores Uncontrollable sweating of the hands, feet, and/or armpits PMS Restless leg syndrome, that is constant jerking or motion of the legs at night Chronic knee and/or hip pain Constipation or sluggish colon Nervous agitation Repeated tapping of the hands or feet None of these apply Do you have high blood pressure?* Yes No Do you have heart disease and/or angina pectoris?* Yes No Do you have osteoporosis?* Yes No Do you drink alcohol on a daily basis?* Yes No Do you have a history of kidney stones?* Yes No Do you suffer from chronic kidney disease?* Yes No Do you regularly take diuretic drugs?* Yes No Are you a sugar addict?* Yes No Do you regularly consume soda pop or other beverages sweetened with sugar?* Yes No Do you eat sweets regularly?* Yes No
