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Type of ID CCT.I.NIE
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Allergies YesNo
Recent surgeries YesNo
Chronic Illnesses YesNo
Have diabetes?? YesNo
Any heart related condition?? YesNo
Do you practice any sport on a regular basis? (Which one)
Do you have medical clearance for this kind of exercise? YesNo
How would you rate your physical condition (Bad-1, Very good-5) 12345
Do you suffer of a mental health that requires psychiatric medication? YesNo
Do you take blood thinners? SiNo
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