Your Intake
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A few health and safety questions
Standard for everyone. Answer as accurately as you can — Dr. Kakli reads all of it.
Are you currently pregnant, breastfeeding, or trying to conceive?
Yes
No
Do you have a personal history of cancer, or are you currently being treated for cancer?
Yes
No
Do you have a personal or family history of melanoma or unusual moles?
Yes
No
Do you have heart disease, uncontrolled high blood pressure, heart failure, or a history of stroke?
Yes
No
Do you have a bleeding disorder, or are you on blood thinners?
Yes
No
Do you have a diagnosed bipolar disorder, psychotic disorder, or severe anxiety disorder?
Yes
No
Do you have gastroparesis or another significant GI motility condition?
Yes
No
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