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Are you currently receiving any medical treatment from a doctor/hospital/clinic? ---YesNo
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Are you allergic to any food, medicines or substances? E.g. latex or penicillin. ---YesNo
If Yes, please provide details:
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Do you suffer from arthritis? ---YesNo
Do you smoke? ---YesNo
Do you have bruising or persistent bleeding following injury, tooth extraction or surgery? ---YesNo
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Have you ever had Hepatitis? ---YesNo
Did you have a surgical and/or plastic surgery before?---YesNo
If yes, please provide details (when? at least year and month information is required):
Are you taking any vitamin supplement? ---YesNo
If Yes, please provide details (A, B, B12, C, D and etc.) :
Are you taking any blood thinner medication? ---YesNo
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