Please select Yes or No for each of the following questions.
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Musculoskeletal: Do you suffer from headaches, muscle, back or joint pain?
Gastrointestinal: Do you suffer from IBS, Crohn’s disease or diverticulitis?
Dermatological: Do you suffer from hives, eczema or psoriasis?
Respiratory: Do you suffer from asthma, bronchitis, seasonal allergies or hay fever?
Auto-immune: Do you suffer from any auto-immune condition such as MS, lupus or rheumatoid arthritis?
Immunological: Do you suffer from food allergies, chronic infections or frequent illness?