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List Any Medical Problems
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Do You Smoke?
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Do You Use Recreational Drugs?
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Have You Lived Outside the Country?
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If Yes, Where?
If Yes, For How Long?
Have You Had a Tattoo Placed in the Last 12 Months?
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Have You Had Any Piercings in the Last 12 Months?
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Have You Ever Had Trouble Getting Pregnant?
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Have You Ever Been Treated for an STD (e.g. Chlamydia, Gonorrhea, Syphilis) in the Past 12 Months?
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If Yes, Which One(s)
Have You Donated Your Eggs Before?
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If Yes, How Many Times?
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