Are you under a physician's care now?
Have you ever been hospitalized or have a major operation
Have you ever had a serious head or neck injury ?
Are you taking any medications, pills, or drugs
Do you take, or have taken, Phen-Fen or Redux?
Are you on a special diet?
Do you use tobacco?
Do you use control substance?
Are you allergic to any of the following?
Do you have, or have had, any of the following: