Client Pre-Screen Questionnaire 2023 | Client Pre-Screen Questionnaire 2023 – Fillable
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Alcohol
Aviation
Avocation
Driving
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Scuba Diving
Substance Use
Tobacco
Travel
ADHD
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Arthritis
Asthma Angioplasty
Atrial Fibrillation
Autism
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Bundle Branch Block
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Congestive Heart Failure
COPD
Coronary Artery Disease
Coronary Bypass
Crohn’s Disease
Cushing Syndrome
Dementia – Alzheimer’s
Depression
Diabetes
Diverticular Disease
Down Syndrome – Intellectual Disability
Eating Disorders
Emphysema
Enlarged Heart
Epilepsy / Seizure Disorder
Glomerulonephritis
Headache
Heart Attack
Heart Attack – Myocardial Infarction
Heart Failure
Heart Murmur
Heart Surgery – Valvular
Hemochromatosis
Hepatitis
Hypercoagulable Disorder
Hyperglycemia
Hypertension
Irregular Heartbeat
Kidney Function Tests
Kidney Transplant
Leukemia
Liver Test
Lung Disease
Lupus
Lymphoma
Mental Health
Mitral Valve Disorder
Mitral Valve Prolapse
Multiple Sclerosis
Neuromuscular
Pacemaker
Pancreatitis
Panhypopituitarism
Paralysis – Similar Physical Disability
Parkinson’s Disease
Personality Disorders
Pheochromocytoma
Pituitary Dysfunction
Polycystic Kidney Disease
Polycythemia
Polyp, Cyst, Tumor or Growth
Prostate Benign
Proteinuria
PSA Elevated
Sarcoidosis
Scleroderma / Crest
Sickle Cell Anemia
Sleep Apnea
Spinal Cord Injury – Paralysis
Stent
Stroke – TIA
T Wave Changes
Thrombosis – Hypocoagulable Clotting Disorder
Thyroid Disease
Valvular Heart Surgery
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