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Full Name
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First
Last
Phone
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Email
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Date of Birth
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Current Weight
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Current Height
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Ethnicity:
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Caucasian
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What’s your highest education level?
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Which city and state are you currently living in?
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Has no medical problems?
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Has no psychological problem before?
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Do you smoke?
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Do you drink alcohol?
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How often?
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Do you use any drugs? Including marijuana?
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