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Do you have a Vitamin C (Ascorbic acid ) allergy?

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Do you have a Vitamin D allergy?

Yes No

Do you have thalassemia, G6PD, or Sickle Cell disease?

Yes No

Do you have Leber’s optic neuropathy, polycythemia vera, iron or folic acid deficiency anemia?

Yes No

Are you on anti-Coagulant therapy?

Yes No

Do you have or are you prone to hemochromatosis?

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Are you taking atorvastatin (Lipitor), orlistat (Xenical, Alli), or hydrochlorothiazide (Microzide) ?

Yes No

Do you have any heart related disorders?

Yes No

Are you pregnant, planning to become pregnant, or breastfeeding?

Yes No