Health Check
Do you have high blood pressure?
Yes
No
Do you have diabetes?
Yes
No
Do you have goiter (thyroid gland) disease?
Yes
No
Do you have a bleeding disorder?
Yes
No
Do you have hepatitis / HIV (AIDS) or another disease carrier?
Yes
No
Do you have kidney disease?
Yes
No
Do you have lung diseases such as asthma?
Yes
No
Do you have heart disease?
Yes
No
Do you have skin disease or hair growth?
Yes
No
Any rheumatic diseases (such as joint rheumatism, rheumatoid arthritis)?
Yes
No
Do you consume herbal teas?
Yes
No
Do you have smoking, alcohol or substance use?
Yes
No
Do you have a pregnancy status?
Yes
No
Are you using birth control pills?
Yes
No

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