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<!--Generated by Squarespace Site Server v5.8.0 (http://www.squarespace.com/) on Sat, 07 Nov 2009 22:02:02 GMT--><rdf:RDF xmlns:rdf="http://www.w3.org/1999/02/22-rdf-syntax-ns#" xmlns:rss="http://purl.org/rss/1.0/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:sy="http://purl.org/rss/1.0/modules/syndication/" xmlns:admin="http://webns.net/mvcb/" xmlns:content="http://purl.org/rss/1.0/modules/content/" xmlns:cc="http://web.resource.org/cc/"><rss:channel rdf:about="http://allergyexpert.squarespace.com/autoimmune-survey/"><rss:title>Free Autoimmune Survey from DNA Allergy Relief</rss:title><rss:link>http://allergyexpert.squarespace.com/autoimmune-survey/</rss:link><rss:description></rss:description><dc:language>en-US</dc:language><dc:date>2009-11-07T22:02:02Z</dc:date><admin:generatorAgent rdf:resource="http://www.squarespace.com/">Squarespace Site Server v5.8.0 (http://www.squarespace.com/)</admin:generatorAgent><rss:items><rdf:Seq><rdf:li rdf:resource="http://allergyexpert.squarespace.com/autoimmune-survey/2009/7/23/take-this-free-autoimmune-risk-survey.html"/></rdf:Seq></rss:items></rss:channel><rss:item rdf:about="http://allergyexpert.squarespace.com/autoimmune-survey/2009/7/23/take-this-free-autoimmune-risk-survey.html"><rss:title>Take this Free Autoimmune Risk Survey</rss:title><rss:link>http://allergyexpert.squarespace.com/autoimmune-survey/2009/7/23/take-this-free-autoimmune-risk-survey.html</rss:link><dc:creator>DR. TED EDWARDS</dc:creator><dc:date>2009-07-23T20:42:29Z</dc:date><dc:subject></dc:subject><content:encoded><![CDATA[<!-- Begin myContactForm.com Form HTML -->
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<input name="user" type="hidden" id="user" value="chiroted" /><input name="formid" type="hidden" id="formid" value="165136" /><input name="subject" type="hidden" id="subject" value="How DNA Allergy Relief can overcome AutoImmune Disease" />
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<tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"> E-mail Address:<font color="#FF0000"> *</font></font></td><td><input name="email" type="text" id="email" size="20" maxlength="100" /></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial">In the recent past have you? (check all that apply)<font color="#FF0000"> *</font></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[1]" type="hidden" value="checkbox165136" /><input name="checkbox1[]" type="checkbox" value="Eaten any Wheat or Corn" />Eaten any Wheat or Corn<br /><input name="checkbox1[]" type="checkbox" value="Been sick causing you to take Anti-Biotics" />Been sick causing you to take Anti-Biotics<br /><input name="checkbox1[]" type="checkbox" value="Had boughts of bloating" />Had boughts of bloating<br /><input name="checkbox1[]" type="checkbox" value="Felt tired, fatigued or frazzeled during the day" />Felt tired, fatigued or frazzeled during the day<br /><input name="checkbox1[]" type="checkbox" value="Been told you have a Thyroid or Adrenal Problem" />Been told you have a Thyroid or Adrenal Problem<br /><input name="checkbox1[]" type="checkbox" value="Experienced chronic pain - like Fibromyalgia or RA" />Experienced chronic pain - like Fibromyalgia or RA<br /><input name="checkbox1[]" type="checkbox" value="Wondered if the things you are taking are working" />Wondered if the things you are taking are working<br /><input name="checkbox1[]" type="checkbox" value="Felt like you have Brain Fog or Memory Loss" />Felt like you have Brain Fog or Memory Loss</font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial">I Suffer From (mark all the apply)</font></td><td><font color="#000000" size="2" face="Arial"><input name="q[23]" type="hidden" value="checkbox165136" /><input name="checkbox23[]" type="checkbox" value="High Blood Pressure and/or Heart Disease" />High Blood Pressure and/or Heart Disease<br /><input name="checkbox23[]" type="checkbox" value="Aches and/or Pain that will not go away" />Aches and/or Pain that will not go away<br /><input name="checkbox23[]" type="checkbox" value="Bleeding Gums (Peridontal Disease)" />Bleeding Gums (Peridontal Disease)<br /><input name="checkbox23[]" type="checkbox" value="Belly Fat and/or Weight Gain" />Belly Fat and/or Weight Gain<br /><input name="checkbox23[]" type="checkbox" value="Morning Stiffness - Arthritis" />Morning Stiffness - Arthritis<br /><input name="checkbox23[]" type="checkbox" value="Burnout, Depression, Anxiety Disorder" />Burnout, Depression, Anxiety Disorder<br /><input name="checkbox23[]" type="checkbox" value="Skin sores / Rashes that you cannot get rid of" />Skin sores / Rashes that you cannot get rid of<br /><input name="checkbox23[]" type="checkbox" value="Allergies / Sinus Problems" />Allergies / Sinus Problems<br /><input name="checkbox23[]" type="checkbox" value="Deteriorating Health over several years" />Deteriorating Health over several years<br /><input name="checkbox23[]" type="checkbox" value="Rheumatoid Arthritis, Diabetes, Lupus" />Rheumatoid Arthritis, Diabetes, Lupus<br /><input name="checkbox23[]" type="checkbox" value="A chronic injury / infection" />A chronic injury / infection</font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial">How bad are things now?</font></td><td><font color="#000000" size="2" face="Arial"><select name="q[2]" ><option value="Please Select">Please Select</option><option value="0-1 I practice preventive medicine">0-1 I practice preventive medicine</option><option value="1-3 My symptoms are not that intense">1-3 My symptoms are not that intense</option><option value="4-5 Theres something wrong. I ignore it.">4-5 Theres something wrong. I ignore it.</option><option value="6-8 Things have gotten pretty bad">6-8 Things have gotten pretty bad</option><option value=&#8221;9-10 I need to renew and regenerate now</opt">9-10 I need to renew and regenerate now</opt</option></select></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial">How often do your symptoms occur?</font></td><td><font color="#000000" size="2" face="Arial"><select name="q[3]" ><option value="Please Select">Please Select</option><option value="Almost every day">Almost every day</option><option value="Once or twice a week">Once or twice a week</option><option value="A few times a month">A few times a month</option><option value="Often, especially when the weather changes">Often, especially when the weather changes</option><option value="Not often, but its still annoying">Not often, but its still annoying</option></select></font></td></tr><tr bgcolor="#FFFFFF"><td colspan="2"><font color="#000000" size="2" face="Arial">Do you have an idea what is going wrong?</font></td></tr><tr bgcolor="#FFFFFF"><td colspan="2"><font color="#000000" size="2" face="Arial"><textarea name="q[8]" cols="30" rows="6" >What have you found out so far?</textarea></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial">What kind of treatment or supplements do you prefer?<font color="#FF0000"> *</font></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[7]" type="hidden" value="checkbox165136" /><input name="checkbox7[]" type="checkbox" value="I prefer things I can use to heal myself. I am a do-it-yourselfer" />I prefer things I can use to heal myself. I am a do-it-yourselfer<br /><input name="checkbox7[]" type="checkbox" value="Something hands-on like Chiropractic, Naturopathic or Accupuncture" />Something hands-on like Chiropractic, Naturopathic or Accupuncture<br /><input name="checkbox7[]" type="checkbox" value="Taking Nutritional Supplements (pills) works for me" />Taking Nutritional Supplements (pills) works for me<br /><input name="checkbox7[]" type="checkbox" value="I use protein drinks, green drinks, tinctures" />I use protein drinks, green drinks, tinctures<br /><input name="checkbox7[]" type="checkbox" value="I take prescription drugs, but I do not like them" />I take prescription drugs, but I do not like them<br /><input name="checkbox7[]" type="checkbox" value="I would like to fix things permanently with DNA Reprograming" />I would like to fix things permanently with DNA Allergy Relief</font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial">How Old do you Hope to be When you Pass Away?</font></td><td><font color="#000000" size="2" face="Arial"><input name="q[22]" type="hidden" value="checkbox165136" /><input name="checkbox22[]" type="checkbox" value="Less than 70" />Less than 70<br /><input name="checkbox22[]" type="checkbox" value="70-80" />70-80<br /><input name="checkbox22[]" type="checkbox" value="81-90" />81-90<br /><input name="checkbox22[]" type="checkbox" value="91-100" />91-100<br /><input name="checkbox22[]" type="checkbox" value="101-110" />101-110<br /><input name="checkbox22[]" type="checkbox" value="111 and beyond" />111 and beyond</font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial">First name:<font color="#FF0000"> *</font></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[10]" type="text" value="" size="25" maxlength="25" /></font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial">Last name:<font color="#FF0000"> *</font></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[11]" type="text" value="" size="" maxlength="20" /></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial">Male, Female - Age</font></td><td><font color="#000000" size="2" face="Arial"><input name="q[12]" type="hidden" value="checkbox165136" /><input name="checkbox12[]" type="checkbox" value="Male" />Male<br /><input name="checkbox12[]" type="checkbox" value="Female" />Female<br /><input name="checkbox12[]" type="checkbox" value="17 or under" />17 or under<br /><input name="checkbox12[]" type="checkbox" value="18-29" />18-29<br /><input name="checkbox12[]" type="checkbox" value="30-39" />30-39<br /><input name="checkbox12[]" type="checkbox" value="40-49" />40-49<br /><input name="checkbox12[]" type="checkbox" value="50-59" />50-59<br /><input name="checkbox12[]" type="checkbox" value="60-69" />60-69<br /><input name="checkbox12[]" type="checkbox" value="70+" />70+</font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial">Contact Phone Number<font color="#FF0000"> *</font></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[13]" type="text" value="" size="" maxlength="20" /></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial">Free 15 minute Consultation - a $22.50 Value<font color="#FF0000"> *</font></font></td><td><font color="#000000" size="2" face="Arial"><select name="q[16]" ><option value="Please choose from one of the following">Please choose from one of the following</option><option value="I would like my Free Consultation by Email">I would like my Free Consultation by Email</option><option value="I prefer a Free Phone Consultation with the Doctor">I prefer a Free Phone Consultation with the Doctor</option><option value="I am just curious. I do not want a free consultation.">I am just curious. I do not want a free consultation.</option></select></font></td></tr><tr><td colspan="2"><hr size="1" /></td></tr>
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