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Have you suffered at any time with
heart, circulation, blood pressure, angina, chest
pain, palpitations?
Have you at any time had chest or
heart surgery?
Have you any history of alcohol
or drug abuse in the last five years?
Are you taking medication for asthma?
Have you at any time had blackouts,
faints or dizziness?
Have you had any ear problems in
the last ten years?
Do you have any colostomy problems?
Have you ever had epilepsy or fits?
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Have you ever had back problems?
Have you any psychological illness?
Do you have diabetes?
Have you ever had a collapsed lung,
pneumothorax or any other chest and lung disease?
Are you currently taking any
medication or under the doctor?
Have you ever been treated for
decompression illness?
Have you had recurrent migraines?
Have you ever had any other disease
of the brain or nervous system?
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