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Medical History
Your health history and related information, needed to make accurate assessments
Do you drink or smoke?
Both
Yes, drink
Yes, smoke
No
Are you on hormone pills or birth control?
Both
Yes, hormone
Yes, birth
No
Do you have, or in the past had, any of the following diseases?
None
Diabetes
Hypertension
Anemia
Heart Disease
Cancer
Do you take any medications?
Yes, regularly
Yes, sometimes
No
Have u had any surgery before?
Yes
No
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