| 1. Do you sneeze often? |
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| 2. Do you ever get headaches? |
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| 3. Are you currently sexually active? |
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| 4. Are you happy with your current weight? |
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| 5. Do you smoke? |
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| 6. Do you have insomnia or trouble sleeping/falling asleep? |
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| 7. Are you sick a lot? |
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| 8. When you are sick, which is your worst symptom? |
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| 9. Are you active? |
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| 10. Are you gassy? (vegetarians check yes) |
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| 11. Which is your biggest health concern? |
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| 12. What problems do you encounter when exercising/ extensive activity? |
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