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Holistic Therapies Screening
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Medical Questionnaire
Are you currently experiencing OR ever been diagnosed with any of the following conditions?
Lower back pain
Pelvic pain
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Have you ever had an episode of Lower back pain?
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Have you had any recent injuries or surgery?
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Which, if any, of the following conditions have you been diagnosed with or had treatment for
Asthma
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Diabetes (Type 2)
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