 | How old are you? | |
 | How often do you smoke? | |
 | Choose the option that best describes your diet. | |
 | Have you ever had a hernia? | No Yes |
 | How tall are you? | |
 | How often do you drink alcohol? | |
 | Please choose the option that best describes your body type. | |
 | Do you have any rare medical disorders, such as elephantitis? | No Yes |
 | Are you an albino? | No Yes |
 | Do you have any kind of hindered mobility - such as having a prosthetic limb or being paraplegic? | No Yes |
 | Have you ever had your appendix removed? | No Yes |
 | Choose the option that best describes the hair on your head. | |
 | How is your vision? | |
 | How frequently do you take pain relievers such as advil, ibuprofen, or codeine? | - Name That Drug! - |
 | How much exposure do you have to the sun? | |
 | Do you work in an environment where you might be exposed to noxious chemicals, such as lead or asbestos? This includes those who work with ceramics, lead, or processed materials. | |
 | Do you regularly drink beverages high in sugar, such as soda or energy drinks? | No Yes |
 | Have you ever been prescribed any anti-psychotic medication, such as lithium or seroquel? | No Yes |
 | Have you ever had any serious surgery, such as heart or intestinal surgery? | No Yes |
 | Are you diabetic? | No Yes |
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