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Old 09-03-2010, 07:17 AM   #27
Orion
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Join Date: Apr 2010
Location: Oregon, USA
Posts: 46
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Orion is an unknown quantity at this point
1) Do you have or have you had any of the following?

[x] 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)
[ ] 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

2) Do you have a family history of any of the following?

[ ] SIDS
[x] Asthma
[x] 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

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
[ ] Exceptionally intelligent

4) Do you have a family history of any of these?

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

5) Do you smoke?
Never.

6) Do you drink?
Never.

7) Do you use any other recreational drugs?
Nope.

8) Are you on any long term medications?
Yes (see below).

9) How often and what kind of over the counter medications?
Albuterol inhaler, used once per day.

10) How much caffeine do you ingest per day?
2 cups of coffee in the morning, and (rarely) a latte later in the day.

11) Do you drink energy drinks?
Never.

12) Qualify your diet, on a scale of Poor>Okay>Good>Excellent.
Good.

13) How many times a week do you work out?
I used to take a 4-mile jog every morning, along with a half-hour yoga routine. Now that school's in session, I only jog on the weekends; I still do yoga in the afternoons, and occasionally I practice kendo or go for a nontechnical rock climbing.

14) How active are you?
Moderately so.

15) Generally, how healthy are you?
Pretty average, although I get hit hard by disease in the winter.

16) Have you ever broken, sprained, strained or torn any bones, muscles, ligaments, or tendons?
Not that I'm aware of.

17) Have you ever needed stitches?
Nope.

18) Any significant early childhood trauma, emotional or physical?
Again, nope.

19) Please state your age of puberty onset, age you became sexually active, any erectile dysfunctions, and your sperm count (if known).
Puberty onset was around 14-15, sexually active by 18, no erectile problems, and no idea as to the sperm count.
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