Health Check Form Obesity

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Blood transfusion
Anemia
Asthma/Emphysema:
Arthritis:
Bladder or Kidney Infections
Blood Clots/Bleeding disorders
Chronic Diarrhea
Diverticulosis
Diabetes
Epilepsy or Seizures
Gallstones/Gallbladder Disease
Gout
Heart Disease
Cholesterol
High Blood Pressure
Kidney Disease/Stones
Liver Disease/Hepatitis
Lung Disease/Pneumonia
Polyps
Rheumatic Fever
Sleep apnea
Stroke
Thyroid Disease/Goiter
Ulcers (stomach or intestinal)
Reflux
Sexually-transmitted disease
Smoking
Alcohol
Acceptence
Please enable JavaScript in your browser to complete this form.
Blood transfusion
Anemia
Asthma/Emphysema:
Arthritis:
Bladder or Kidney Infections
Blood Clots/Bleeding disorders
Chronic Diarrhea
Diverticulosis
Diabetes
Epilepsy or Seizures
Gallstones/Gallbladder Disease
Gout
Heart Disease
Cholesterol
High Blood Pressure
Kidney Disease/Stones
Liver Disease/Hepatitis
Lung Disease/Pneumonia
Polyps
Rheumatic Fever
Sleep apnea
Stroke
Thyroid Disease/Goiter
Ulcers (stomach or intestinal)
Reflux
Sexually-transmitted disease
Smoking
Alcohol
Acceptence
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