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VI. Detailed Autoimmune Disease History, Optional
Please, enter your first name followed by last name

Auto Immune History

Please select all that apply
Please list all
Please select all that apply
Please include medicine, dosage and duration
Please list all
Example: remove certain food groups, participating in strength, relaxation or rehabilitation classes, etc

Health Goals

Examples: long term financial cost, negative side effects, long term risk, less time spent visiting doctors, etc
* Required field