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Medical Issues Questionnaire
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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Medical history questionnaire
1
Do you have any existing medical conditions?
Choose yes or no.
Yes
No
2
Rate your overall health from 1 to 5:
Rate your health on a scale from 1 (poor) to 5 (excellent).
3
If yes Please describe any medical issues you have:
Provide details about your medical issues.
4
Have u experienced any recent illness or injuries (within the past 6 months )?
Select one answer
Yes
No
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