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Allergies
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Sports Physical Exam
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Anxious
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Asthma
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Attention Problems
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Back Problems
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Broken/ Fractured Bones
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Cold
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Cough
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Depression
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Dizzy
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Earache
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Diabetes
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Diarrhea
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Facial Questions
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Heartburn
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Headache
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Weekly Recur Exam
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Shoulder Pain
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Difficulty Breathing
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Neck Pain
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Difficulty Swallowing
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Wrist Pain
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Difficulty Urinating
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Eye Drainage
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Facial Pain
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Fever
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High Blood
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Please describe your symptoms:
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When did your symptoms start?
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Pain Scale; 0=NO PAIN, 10=WORST PAIN
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What alleviates and/or aggravates your symptoms?
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What do you believe caused your symptoms?
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Was your injury due to an work or auto accident?
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Pain Diagram
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