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?*YesNoDo you have heart disease and/or angina pectoris?*YesNoDo you have osteoporosis?*YesNoDo you drink alcohol on a daily basis?*YesNoDo you have a history of kidney stones?*YesNoDo you suffer from chronic kidney disease?*YesNoDo you regularly take diuretic drugs?*YesNoAre you a sugar addict?*YesNoDo you regularly consume soda pop or other beverages sweetened with sugar?*YesNoDo you eat sweets regularly?*YesNo