SYMPTOMS REGISTRATION

1. Have you experienced recent weight loss?

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2. Do you feel extremely tired?

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3. Do you experience overall weakness in your body?

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4. Do you experience increased heart rate and palpitations?

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5. Do you have loose stools?

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6. Do you feel like you cannot tolerate heat?

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7. Have you had a recent thyroid test done?

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SYMPTOMS REGISTRATION
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Any current health condition diagnosis?

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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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