| Supplements Consumed | Never or <1 per mo. |
1–3 per mo. |
1 per wk |
2–4 per wk |
5–6 per wk |
1 per day |
2–3 per day |
4–5 per day |
6+ per day |
| 1.Multiple Vitamin, 1 Tablet | |||||||||
| 2.Calcium Vitamin, 1 Tablet | |||||||||
| 3.Vitamin D, 1 Tablet (list amount __________) |
|||||||||
| 4.Calcium + Vitamin D (Viactiv), 1 Tablet | |||||||||
| 5.Kelp (or other iodine supplement), 1 Tablet |
|||||||||
| If you take any of the above, please list which you use, brand name, etc. | |||||||||
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