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CONTACT AND HEALTH HISTORY

Childhood Health Issues.

Please tick those that applied to your situation.

Were you Breastfed?

Were you Bottle Fed?

Normal Birth? 

Caesarean Section Birth? 

Complications at Birth? 

General Health Questions.

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Contact Information

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General Health Information

Blood Type

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Current Health Concerns

Current Infection

Mental Health Issues

Inflammation

Auto-Immune Issues