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Yes |
No |
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Do you use any Performance Enhancing Medication |
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Are you on any Chronic Medication |
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Do you suffer from any
one of the following: |
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1. Cardiovascular Problems |
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2. Respiratory Problems |
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3. Endocrine Problems (Diabetes) |
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4.Musculoskeletal Problems |
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5. Central Nervous System Disorders (Fainting, epilepsy, etc) |
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6. Major Illness within last year |
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7. Gastro Intestinal Problems |
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8. Any family history of Heart Disorders |
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If you have answered YES to any of the above, supply
details: |
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YES |
NO |
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Have you undergone any surgical procedures in the last two
years? |
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If yes, give details: |
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Are you allergic to anything? |
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If yes, give details: |
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Have you ever suffered from a heat disorder or anaesthetic
problem? |
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If yes, give details: |
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Are you currently taking medications? |
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If yes, give details: |
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