Dr. Joe for HOPE Toxicologist, Dr. Joe Nieusma, PhD, breaks down the world's top diseases and how research proves the transformative benefits of Carbon 60. Fields marked with an * are required First Name * Last Name * Address * City * Zip * State * - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Phone * Birthday * Email * Height * Weight * How often do you smoke tobacco products? * Never Sometimes Often How often do you smoke cannabis? * Never Sometimes Often How often do you drink alcohol? * Never Sometimes Often How often do you exercise? * Never Sometimes Often Divider List all drugs that are prescribed for you with their dosage. * With your prescribed drugs, list any side effects or dosage change over time. * List all over-the-counter drugs that you taking with their dosage. * With your OTC drugs, list any side effects or dosage change over time. * List all supplements that you taking, along with their dosage. * List any significant medical events that we should know about. * If you are a human seeing this field, please leave it empty. Fields marked with an <span class="ninja-forms-req-symbol">*</span> are required First Name * Last Name * Address * City * Zip * State * - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Phone * Birthday * Email * Height * Weight * How often do you smoke tobacco products? * Never Sometimes Often How often do you smoke cannabis? * Never Sometimes Often How often do you drink alcohol? * Never Sometimes Often How often do you exercise? * Never Sometimes Often Divider List all drugs that are prescribed for you with their dosage. * With your prescribed drugs, list any side effects or dosage change over time. * List all over-the-counter drugs that you taking with their dosage. * With your OTC drugs, list any side effects or dosage change over time. * List all supplements that you taking, along with their dosage. * List any significant medical events that we should know about. * If you are a human seeing this field, please leave it empty.