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Do you consider yourself healthy?
Are you a smoker now?
If no, have you ever smoked?
If yes, when did you quit smoking?
Do you exercise regularly?
If yes, please state the activities and frequency of exercise:
Do you drink coffee?
If yes, please state the approximate amount per day:
Are you taking nutritional supplements?
If yes, please mention what brand:
Please indicate if there is any history of the following diseases in your family:?
Do you feel stressed mostly all of the time?
Do you feel that stress is caused or related to the situation at your job, relationship or financial challenges or something else?
Do have a good 8-9 hours of sleep every night?
Would you like to change something in your life?
If yes, please mention what would that be:
If Yes, do you believe this is possible?
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