Health Questionnaire – WCSD

If you are unsure or do not have the information, you may input N/A and move to the next section.

  • Patient Information and Consent

  • Health risk may vary depending on ethnicity
  • Biometrics

  • Miscellaneous

  • June 2020

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    June 30, 2020

DISCLAIMER: This is not an insurance product. Many of the items may not be covered by your insurance company and therefore will be your responsibility. Healthcare professional availability for certain services may be dependent on licensure, scope of practice restrictions, or other requirements in the state. The information provided is not a substitute for your doctor’s care and should be used as a practical guide to better health through lifestyle choices.

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