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PLEASE LIST THE TYPE AND DOSAGE OF ALL
prescription and over the counter medications, or nutritional (dietary) supplements that you are currently taking:* SAIDS and NSAIDSVitaminsChinese herbsName and dosage of supplementno |
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Please CHECK any of the following whose care you are under:* General Practitioner(Physiatrist)General Practitioner(Orthopedic)Sports MassageChinese MassageChiropractor / OsteopathChinese Medicineno |
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Nausea / VomittingWeaknessFever/ChillsSweatPregnancy |
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