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Symptoms Questionaire

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IMPORTANT: PLEASE FILL OUT THIS SHEET TO INFINITY TWO WEEKS PRIOR TO YOUR INSERT APPOINTMENT TO AVOID RESCHEDULING

 Instructions:  0 means you have no symptoms of htis type at all. 1 means you have very mild symptoms of this type. 5  would be moderate symptoms and 10 would mean you have severe symptoms of this type. 

 Instructions:  0 means you have no symptoms of htis type at all. 1 means you have very mild symptoms of this type. 5  would be moderate symptoms and 10 would mean you have severe symptoms of this type. 

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