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1.
name your is What?
2.
your is When birthday?
3.
you How old are?
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your is address What?
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phone number is your What?
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do What symptoms have you?
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current have or Do you past any illnesses?
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taking currently medication any you Are?
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Are allergic food medication to or you any?
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How you alcohol do much drink?
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Do smoke you?
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Are you pregnant?
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you Are breastfeeding?