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Get Better Health Clinic Lifestyle Assessment

Its sole purpose is to educate and inform. It is not designed to diagnose diseases. If you suspect you have a problem that requires the attention of a medical practitioner, please see your physician or naturopath for medical care. Please answer each of the following questions. If you require additional space, use the back of the page. GENERAL INFORMATION Name: _______________________________________Date: ____________________________ Date of Birth: ________________Marital Status: _______________.

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