Date of birth:
Tobacco / Nicotine use:
Rate your health:
You're in very good overall health. Your weight, blood pressure, and cholesterol are all normal, and you have an uneventful medical history. You take no more than 1 prescription medication.
You're in average health and may have one or more medical conditions that require treatment or medication, but they don't impact your daily life.
You have chronic medical conditions that require treatment and you take several maintenance medications.
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