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Ry Rd Conroe, Texas 77301 Religion Education Level Have you, your spouse, or a blood relative ever had the following Yourself Yes Diabetes Thyroid problems Dizziness or fainting Heart Trouble or chest pain High blood pressure Asthma Hay fever or allergies Pneumonia Bowel / GI disorder Stomach ulcers Bleeding or blood disorder / Anemia Cancer Blindness or Glaucoma Deafness Neurologic disease(including Seizures) Stroke Depression Nervousnes Mental retardati.

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