SYMPTOMS REGISTRATION

1. Have you suffered from recurrent sore throat?

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2. Do you feel feverish on/off?

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3. Do you experience muscle weakness and/or pain?

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4. Do you feel that you are tired for long periods of time after any exercise?

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5. Do you suffer from headaches?

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6. Do you suffer from sleep disturbances?

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7. Have you ever suffered with depression?

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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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