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What is the condition that you need help with?
Select A Choice
Stress Management
Insomnia
Hypertension
Muscle Tension
Grinding Teeth/Jaw
Headache
Irritable Bowel Syndrome (IBS)
Other
When Did it Start?
Less Than A Week
Weeks Ago
3 Months Ago
6 Months Ago
More than 6 Months
More Than 1 Year
Are You Currently Taking Any Medication?
NO
YES
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