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Are you having any problems with your sleep habits No Yes 4. If yes check where applicable Sleeping too little Sleeping too much Poor quality sleep Disturbing dreams Other Restricting 6. How is your physical health at present Poor Unsatisfactory Satisfactory Good Very Good 2. Please list any persistent physical symptoms or health concerns e.g. chronic pain headaches hypertension diabetes etc. 3. In the last year have you experienced any significant life changes or stressors Page 2 Have you...
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