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HEALTH HISTORY Please check X all present symptoms HEAD MID-BACK Feet feel cold Headaches Mid back pain Swollen ankles R - L Head feels heavy Pain between shoulder blades Swollen feet R - L Tension sharp stabbing pain GENERAL Light-headedness Dull achy pain Heart disease Nausea Pain from front to back Stroke Dizziness Muscle spasms Pace maker Vomiting CHEST Tumors Loss of balance Chest pain Cancer Loss of memory Shortness of breath Diabetes Light bothers eyes Pain around ribs Hypoglycemia...
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