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Please provide the additional health information below so we can determine if you are eligible for the FOUR WEEKS TO WELLNESS course.

Do Any Of The Following Health Conditions Apply To You? (select all that apply)
pregnantprior heart surgeryblood clotscancerbrain traumaschizophreniatransplanted organsnone of the above

Do Any Of The Following Health Conditions Apply To You? (select all that apply)
heart problemsheart diseasechest painsuncontrolled thyroid diseasekidney diseasebrain tumortype I diabetestype II diabetessickle cell anemiauncontrolled blood pressuresevere asthmasevere anxietyCOPDmultiple sclerosisnone of the above

Do Any Of The Following Health Conditions Apply To You? (select all that apply)
high blood pressurelow blood pressuredepressionmigraineshypothyroidismepilepsypanic attacksnone of the above

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