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Page 1: €¦ · Comprehensive Health History Questionnaire Northlake Health Food 10233 E. Northwest Hwy. Suite 506 Dallas, TX 75238 214—341 All questions contained in this questionnaire

Page 2: €¦ · Comprehensive Health History Questionnaire Northlake Health Food 10233 E. Northwest Hwy. Suite 506 Dallas, TX 75238 214—341 All questions contained in this questionnaire

Page 3: €¦ · Comprehensive Health History Questionnaire Northlake Health Food 10233 E. Northwest Hwy. Suite 506 Dallas, TX 75238 214—341 All questions contained in this questionnaire

Page 4: €¦ · Comprehensive Health History Questionnaire Northlake Health Food 10233 E. Northwest Hwy. Suite 506 Dallas, TX 75238 214—341 All questions contained in this questionnaire

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