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Do you have any medical conditions?
Yes
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Gender
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Tobacco Use
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Yes
Height
Height
3 Feet
4 Feet
5 Feet
6 Feet
Height
Inches
0 Inches
1 Inches
2 Inches
3 Inches
4 Inches
5 Inches
6 Inches
7 Inches
8 Inches
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11 Inches
Weight
LBS
Weight
100
105
110
115
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185
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225
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245
250
Household Size
Household Size:
1
2
3
4
5
6
7
8+
Household Income
50000
60000
70000
80000
90000
100000
110000
120000
130000
140000
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160000
170000
180000
190000
100000
210000
220000
230000
240000
250000
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