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Intake Questionnaire
Please check any conditions that apply to you:
CARDIOVASCULAR AND RESPIRATORY
GASTROINTESTINAL AND URINARY
NEUROLOGIC
METABOLIC/ENDOCRINE AUTOIMMUNE
HEMATOLOGY
MUSCULOSKELETAL
CANCER
PSYCHOLOGICAL
WOMEN (non-menopausal)
PAIN
I attest that the information I have provided is true and accurate to the best of my knowledge:
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