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The Survey That Ate Manhattan Discussion of the giant demographic poll being created for Guild research purposes.

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Old 06-08-2009, 11:42 PM   #21
Sanaira Loupied
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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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Old 10-05-2009, 06:07 PM   #22
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Manhattan Survey-medical

Survey that Ate Manhattan: Medical History

--------------------------------------------------------------------------------

You are more than welcome to submit this information to us privately, your data will be kept anonymously, and we consider this information to be highly confidential.


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
[ x]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
[ x]Asthma mother and sister
[ ]Arthritis
[ ]Epilepsy
[ ]Diabetes
[ ]Heart Conditions
[ ]Heart Disease
[ ]Kidney disorders
[ ]Chronic Fatigue Syndrome
[ ]Anemia
[ ]High Blood Pressure
[ ]High Cholesterol
[ x]Cancer grandmother
[ ]Autoimmune disorders
[ ]STD's
[ ]Osteoporosis
[ ]Stroke
[ ]Vision problems (Not counting glasses)
[ x]Wear glasses mother
[ ]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:

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

Anything else you want us to know about

4: Do you have a family history of:

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

Anything else you want us to know about

5: Do you smoke? yes
How much per day 15

6: DO you drink? no

How much per week

7: Do you use any other recreational drugs? no

which and how much

8: Are you on any long term medications?
which? lithium, temezapam, lexapro

9: How often and what kind of over the counter medications? tylenol almost every day

10:How much caffeine? 2-3 cups of coffee
(per day)

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? walk almost every day

14: How active are you? moderately

15: Generally, how healthy are you? very

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

17: Have you ever needed stitches? yes

18: Any significant early childhood trauma, emotional or physical? molested at 6

19a females:
age of menarche (age of first period)12
Do you have a regular cycle yes
Have you ever been pregnant yes
Number of
Abortions 1
miscarriages
stillbirths
vaginal live births 1
C sections
Age of menopause (if appropriate)
Age you became sexually active 17

19b males:

Age of puberty onset
Erectile dysfunctions
Age you became sexually active
normal sperm count (if known)
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Old 11-26-2009, 07:33 AM   #23
mikelj84606
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1: do you have or have you had any of the following :

[ ]Asthma
[ ]Arthritis
[ ]Epilepsy
[ ]Diabetes
[X]Heart Conditions
[ ]Heart Disease
[ ]Kidney disorders
[ ]Chronic Fatigue Syndrome
[ ]Anemia
[X]High Blood Pressure
[X]High Cholesterol
[ ]Cancer
[ ]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

(further information on any check marks)

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

[ ]SIDS
[ ]Asthma
[ ]Arthritis
[ ]Epilepsy
[ ]Diabetes
[X]Heart Conditions
[ ]Heart Disease
[ ]Kidney disorders
[ ]Chronic Fatigue Syndrome
[ ]Anemia
[X]High Blood Pressure
[X]High Cholesterol
[ ]Cancer
[ ]Autoimmune disorders
[ ]STD's
[ ]Osteoporosis
[ ]Stroke
[ ]Vision problems (Not counting glasses)
[X]Wear glasses
[X]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
[X]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
[X]Depression
[ ]Learning disabilities
[ ]Mental Retardation
[X]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

5: Do you smoke? N
How much per day

6: DO you drink? Water...aka ... no

How much per week

7: Do you use any other recreational drugs? N

which and how much

8: Are you on any long term medications? N
which?

9: How often and what kind of over the counter medications? none

10:How much caffeine?
(per day) 2cans of mountain dew

11: DO you drink energy drinks? no just pop

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

13: How many times a week to you work out? 2-3

14: How active are you? I am active about 30% of my week.

15: Generally, how healthy are you? 80% so not perfect

16: Have you ever broken, sprained, strained or torn any bones/muscles/ligaments/tendons broke my radius twice and ulna once on each arm, broke nearly all my fingers at least once, dislocated my right shoulder 3 seperate times a rib that kept rebraking over the course of a few yrs.

17: Have you ever needed stitches? Bicycle accident at age 7, 7 stitches

18: Any significant early childhood trauma, emotional or physical? Family death in the room next to mine, friend death, ran away from home, visited a rapist just after he left my sister in the woods and i dint know he had done that till after i left.

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 N
Age you became sexually active 22
normal sperm count (if known)
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Old 11-27-2009, 06:19 PM   #24
Pat McDonald
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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


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
[ ]High Blood Pressure
[ ]High Cholesterol
[X]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

Both grandfathers, maternal grandmother, mother all died prematurely from cancer.


3: Do you have any of the following:

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

Being exceptionally intelligent could be regarded as a mental illness.


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?
How much per day

6: DO you drink?

How much per week

7: Do you use any other recreational drugs?

which and how much

8: Are you on any long term medications? Cannabis to defer glaucoma.
which? Once per fornight or less often,.

9: How often and what kind of over the counter medications?

10:How much caffeine? About 2 pints of coffee or tea per day.
(per day)

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? Almost never

14: How active are you? Above average. Walker by choice.

15: Generally, how healthy are you? Fair health.

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

Broken toes, fingers. Compound fracture of rib over left kidney. Multiple rib fractures. Major ligament damage left ankle.

17: Have you ever needed stitches? Frequently, although nowadays superglue is used.

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

Burned right hand picking up a soldering gun aged 3.

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 13
Erectile dysfunctions
Age you became sexually active 24
normal sperm count (if known)
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Old 11-27-2009, 06:27 PM   #25
Burrou
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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)
[ ]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

Had braces when young and had neumonia a few months after birth

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
[ ]High Cholesterol
[ ]Cancer
[ ]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

Father has high blood pressure


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

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?
How much per day

NO

6: DO you drink?

no

How much per week

7: Do you use any other recreational drugs?

no

which and how much

8: Are you on any long term medications?
which?

none

9: How often and what kind of over the counter medications?

Nasal spray

10:How much caffeine?
(per day)

none

11: DO you drink energy drinks?

no

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

ok

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

daily run

14: How active are you?

somewhat

15: Generally, how healthy are you?

healthy

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

Sprained my ankle once

17: Have you ever needed stitches?

no

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

neumonia, almost died

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
Erectile dysfunctions
Age you became sexually active
normal sperm count (if known)
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Old 03-10-2010, 10:44 PM   #26
Brightwing
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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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Old 09-03-2010, 07:17 AM   #27
Orion
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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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Old 01-16-2012, 01:14 AM   #28
FXL5
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Posts: 42
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1: do you have or have you had any of the following :

[x]Asthma (Very mild)
[ ]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
[ ]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
[x]Asthma
[ ]Arthritis
[ ]Epilepsy
[ ]Diabetes
[ ]Heart Conditions
[ ]Heart Disease
[ ]Kidney disorders
[ ]Chronic Fatigue Syndrome
[x]Anemia
[ ]High Blood Pressure
[x]High Cholesterol
[x]Cancer
[ ]Autoimmune disorders
[ ]STD's
[ ]Osteoporosis
[x]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
[ ]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? Occasionally
How much per day: About three cigars per year.

6: DO you drink? Yes

How much per week: Varies too much to be useful. Between 0 and 120 units.

7: Do you use any other recreational drugs? No

which and how much:

8: Are you on any long term medications? No
which?

9: How often and what kind of over the counter medications?

10:How much caffeine?
(per day) Approximately 500mg daily. (Pure crystalline, dissolved in Orange Juice) In addition, about five cups of tea and two of coffee.

11: DO you drink energy drinks? No.

12: Qualify your diet (poor, ok, good, excellent) At home, Excellent. At University, Good.

13: How many times a week to you work out? 4-7, depending on how much time is available.

14: How active are you?

15: Generally, how healthy are you? Excellent. Less than ten sick days from school in my entire life, including one six working-day stretch for chicken pox.

16: Have you ever broken, sprained, strained or torn any bones/muscles/ligaments/tendons? Greenstick fracture, six metatarsals. Cleanly healed.

17: Have you ever needed stitches? No.

18: Any significant early childhood trauma, emotional or physical? Not that I recall.

19b males:

Age of puberty onset: Unknown. After ten, before thirteen.
Erectile dysfunctions: No
Age you became sexually active: 14
normal sperm count (if known): No clue.
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Old 01-27-2012, 03:57 AM   #29
Constructman
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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)
[ ]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
[ ]Diabetes
[ ]Heart Conditions
[ ]Heart Disease
[ ]Kidney disorders
[ ]Chronic Fatigue Syndrome
[ ]Anemia
[ ]High Blood Pressure
[ ]High Cholesterol
[x]Cancer
[ ]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
[x]Autism Spectrum Disorders (including Aspergers syndrome)
[ ]Alcoholism or other substance abuse
[ ]Any other addictions
[ ]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?
No

9: How often and what kind of over the counter medications?
None

10:How much caffeine?
(per day)
0-2 cups of hot chocolate/tea per day

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?
0

14: How active are you?
Moderate

15: Generally, how healthy are you?
Good

16: Have you ever broken, sprained, strained or torn any bones/muscles/ligaments/tendons
No?

17: Have you ever needed stitches?
No

18: Any significant early childhood trauma, emotional or physical?
Does having pleural empyema at the age of 4-5 count?

19a females:
age of menarche (age of first period)
N/A

Do you have a regular cycle
N/A

Have you ever been pregnant
N/A

Number of
Abortions
N/A

miscarriages
N/A

stillbirths
N/A

vaginal live births
N/A

C sections
N/A

Age of menopause (if appropriate)
N/A

Age you became sexually active
N/A

19b males:

Age of puberty onset
11-12

Erectile dysfunctions
No

Age you became sexually active
Have not become sexually active yet

normal sperm count (if known)
Umm... How am I supposed to know this?
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Last edited by Constructman; 01-27-2012 at 03:59 AM. Reason: Wrong answer
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Old 08-30-2012, 03:09 PM   #30
Trent
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Join Date: Aug 2012
Posts: 11
Rep Power: 0
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You are more than welcome to submit this information to us privately, your data will be kept anonymously, and we consider this information to be highly confidential.


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)
[ 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
[ ]High Blood Pressure
[ ]High Cholesterol
[ ]Cancer
[ ]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

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
[ x]Exceptionally intelligent

Anything else you want us to know about

5: Do you smoke? Yes
How much per day: 1/2 pack

6: DO you drink? Yes

How much per week: Social, <1/week

7: Do you use any other recreational drugs? No

which and how much N/A

8: Are you on any long term medications? Yes
which? Singulair, Allegra, Albuterol

9: How often and what kind of over the counter medications? Daily, Allegra

10:How much caffeine? 2 cups of coffee
(per day)

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? Once

14: How active are you? Average

15: Generally, how healthy are you? Very Healthy

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

17: Have you ever needed stitches? Yes

18: Any significant early childhood trauma, emotional or physical? No

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

N/A

19b males:

Age of puberty onset: 11
Erectile dysfunctions: No
Age you became sexually active: N/A
normal sperm count (if known): Unknown
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