SYMPTOMS REGISTRATION

1. Do you suffer from high blood pressure?

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2. Are you on any medication for high blood pressure?

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3. Do you suffer from leg cramps?

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4. Do you experience weakness/dizziness?

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6. Do you smoke?

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7. Do you consume alcohol?

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8. Do you lead a sedentary lifestyle?

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9. Are you on any medication, such as aspirin?

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SYMPTOMS REGISTRATION
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Personal Health History

Any current health condition diagnosis?

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Any past health condition?

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Any past hospitalisations/surgeries?

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Have you ever taken any antibiotics?

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Have you ever taken birth control?

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Have you ever been on hormone replacement therapy?

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