Medical Conditions - Please check box if you have had any of the following: 18.0
	Anemia Angina Artifical Heart Valve Blood Disease Congenital Heart Defect Heart Attack - If so when? Heart Condition Heart Murmur Heart Surgery Hemophilia High Blood Pressure High Cholesterol Irregular Heart Beat Leukemia Low Blood Pressure Mitral Valve Prolapse Pacemaker Rheumatic Fever Stents Stroke If so, when?	Acid Reflux Gastrointestinal Disease GERD Stomach Ulcers AIDS Arthritis Cancer: List type Chemotherapy - If so, when? Radiation - If so, when? Herpes HIV Positive HPV Rheumatism Scarlet Fever Sexually Trans Disease Tumors	Diabetes Thyroid Problem Cirrhosis Hepatitis A B C Jaundice Kidney Disease Liver Disease Asthma Bronchitis COPD Emphysema Mouth Breathing Respiratory Problems Sinus Problems Sleep Apnea Snoring Tuberculosis Use Inhaler	Aspergers Syndrome Autism Cerebral Palsy Dizzy Spells/Fainting Epilepsy or Seizures Intellectual Disability Nervous Disorder Nursing Pregnant Due Date Artificial Joints Osteoporosis Detached Retina Glaucoma
	List any other condition you may have