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What is your date of birth?
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Do you use tobacco?
Do you currently have health coverage? If so what company?
Are you being treated for Diabetes?
Are you being treated for Hypertension?
Are you being treated for Cholesterol problem?
Are you being treated for any other medical condition or taking any medication?
No coronary artery disease or cancer deaths of either natural parents prior to age 60.
Are you pregrant?
Have you been hospitlized within the last 5 years
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