Full Name
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Phone
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Email
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Address
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City, State, Zip
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Do you suffer from stiffness in the joints?
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Do you have inflammation of one or more joints?
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Do you have pain and tenderness in one or more joints?
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Do you have joint deformities?
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Have you had an unexplained rapid weight loss?
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Do you have loss of range of motion in one or more joints?
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Do you need over the counter pain killers on a regular basis?
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Do you suffer from an autoimmune Disorder?
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Do you take a multi vitamin/mineral supplement on a daily basis?
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Have you been diagnosed with any form of arthritis?
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