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Please note that the information you provide here will be protected and treated with the utmost confidentiality. These questions help me provide you with the safest environment and highest level of care I can. It is essential to the process that you answer with openness and complete honesty.

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Please select from below if you experience right now any of the mental health conditions listed below or you have experienced in the past:
Please select from below if you experience right now any of the physical health conditions listed below or you have experienced in the past:
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