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Old 03-10-2010, 10:44 PM   #26
Brightwing
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Join Date: Mar 2010
Location: Cassus Aer
Posts: 74
Rep Power: 0
Brightwing 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
[ ]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
[ ]Diabetes
[ ]Heart Conditions
[ ]Heart Disease
[ ]Kidney disorders
[ ]Chronic Fatigue Syndrome
[ ]Anemia
[x]High Blood Pressure ( paternal side)
[x ]High Cholesterol ( paternal side)
[x]Cancer ( paternal side)
[ ]Autoimmune disorders
[ ]STD's
[ ]Osteoporosis
[ ]Stroke
[ ]Vision problems (Not counting glasses)
[ ]Wear glasses
[ ]Auditory problems
[ ]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 ( registered genius )

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
How much per day N/A

6: DO you drink?

No, not often

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?

None, I have no conditions, and never get sick, I have an overactive metabolism, and an off the charts immune system... I'm just lucky.

10:How much caffeine?

400mg?

11: DO you drink energy drinks?

Unless an overload of MT Dew is an energy drink, than no, except the occasional Monster

12: Qualify your diet (poor, ok, good, excellent)

Eh, it's good...

13: How many times a week to you work out?

Daily, or every other day.

14: How active are you?

Fairly

15: Generally, how healthy are you?

Never sick... except once or twice every 3 years

16: Have you ever broken, sprained, strained or torn any bones/muscles/ligaments/tendons

Ankles, Knees... TaeKwonDo takes a toll on you.

17: Have you ever needed stitches?

No

18: Any significant early childhood trauma, emotional or physical?

I had my head run over by a 1 ton 4 wheeler loaded up with friends when I was years old.

19a females:
age of menarche (age of first period)
Do you have a regular cycle
Have you ever been pregnant
Number of
Abortions
miscarriages
stillbirths
vaginal live births
C sections
Age of menopause (if appropriate)
Age you became sexually active

19b males:

Age of puberty onset 12
Erectile dysfunctions
Age you became sexually active -Withholding information-
normal sperm count (if known) -W/I-
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