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Get Name: Application No.: 1. Have You Ever Had, Or Been ... - Bmo.com

O.: 1. Have you ever had, or been told you had: If yes, describe symptoms: a fainting spell aura seizure 2. When was the first episode and type: 3. How often do they occur? 4. Is consciousness lost completely? Yes No If yes, for how long? 5. Do you have any aura or warning of an attack? Yes No 6. Give names and addresses of doctors consulted for any of above, with dates: 7. What medication or treatment was prescribed? 8. If currently taking medication or treatment, specif.

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