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Old 06-08-2009, 11:42 PM   #21
Sanaira Loupied
The lingering Therian shadow.
 
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Join Date: Jun 2009
Location: Canada
Posts: 43
Rep Power: 0
Sanaira Loupied is an unknown quantity at this point
1: do you have or have you had any of the following :

[ ]Asthma
[ ]Arthritis
[ ]Epilepsy
[ ]Diabetes
[ ]Heart Conditions
[ ]Heart Disease
[ ]Kidney disorders
[ ]Chronic Fatigue Syndrome
[ ]Anemia
[ ]High Blood Pressure
[ ]High Cholesterol
[ ]Cancer
[ ]Autoimmune disorders
[ ]STD's
[ ]Osteoporosis
[ ]Stroke
[ ]Vision problems (not counting glasses)
[ X]Wear glasses
[ ]Auditory problems
[X ]Dental problems (including need for braces)
[ ]Hydrocephalus
[ ]Cerebral Palsy
[ ]Spina Bifida
[ ]Other birth defects
[ ]Anything else you think should be listed

(further information on any check marks)

2: Do you have a family history of any of the following:

[ ]SIDS
[ ]Asthma
[ ]Arthritis
[ ]Epilepsy
[X ]Diabetes
[ ]Heart Conditions
[ ]Heart Disease
[ ]Kidney disorders
[ ]Chronic Fatigue Syndrome
[ ]Anemia
[ ]High Blood Pressure
[ ]High Cholesterol
[ ]Cancer
[ ]Autoimmune disorders
[ ]STD's
[ ]Osteoporosis
[ ]Stroke
[ ]Vision problems (Not counting glasses)
[X ]Wear glasses
[ ]Auditory problems
[X ]Dental problems (including need for braces)
[ ]Hydrocephalus
[ ]Cerebral Palsy
[ ]Spina Bifida
[ ]Other birth defects
[ ]Anything else you think should be listed

(list family relation of any with checkmark, and further information)


3: Do you have any of the following:

[ ]Mental illness
[ ]Depression
[ ]Learning disabilities
[ ]Mental Retardation
[ ]Autism Spectrum Disorders (including Aspergers syndrome)
[ ]Alcoholism or other substance abuse
[ ]Any other addictions
[X]Exceptionally intelligent

Anything else you want us to know about

4: Do you have a family history of:

[ ]Mental illness
[ ]Depression
[ ]Learning disabilities
[ ]Mental Retardation
[ ]Autism Spectrum Disorders (including Aspergers syndrome)
[ ]Alcoholism or other substance abuse
[ ]Any other addictions
[ ]Exceptionally intelligent

Anything else you want us to know about

5: Do you smoke?
No

6: DO you drink?

No
7: Do you use any other recreational drugs?

No

8: Are you on any long term medications?
which?
No
9: How often and what kind of over the counter medications?
Almost never
10:How much caffeine?
like none.

11: DO you drink energy drinks?
No
12: Qualify your diet (poor, ok, good, excellent)
good
13: How many times a week to you work out?
haha, none
14: How active are you?
not to bad, I do a lot of running and soccer/ volley ball, tree climbing and such
15: Generally, how healthy are you?
Good
16: Have you ever broken, sprained, strained or torn any bones/muscles/ligaments/tendons
Ankles (sprained) , piles of times.
17: Have you ever needed stitches?
Yes
18: Any significant early childhood trauma, emotional or physical?
Uh, My father emotionally destroyed me every single day of my life when I was a kid.
19a females:
age of menarche (age of first period) Youngish/average, dunno really.
Do you have a regular cycle Yes
Have you ever been pregnant No
Number of
Abortions 0
miscarriages 0
stillbirths 0
vaginal live births 0
C sections 0
Age of menopause (if appropriate) n/a
Age you became sexually active Am not.

19b males:

Age of puberty onset
Erectile dysfunctions
Age you became sexually active
normal sperm count (if known)
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