Please list any medical conditions that you have ever been evaluated for by a physician, admitted to a hospital or
are currently being treated for:
For example:
- HIV/Aids
- Hepatitis C
- Arthritis
- Cancer
- Glaucoma
- Migraine
Headaches
- Weight Loss/Anorexia
- Severe debilitating chronic pain
- Neuropathy
- Severe and persistent muscle
spasms including but not limited to those characteristic of Multiple Sclerosis or Crohn’s Disease
- Seizures
- Severe
Nausea
- High Blood Pressure
- Depression
- Anxiety
- Insomnia
- PTSD
- Heartburn
- Irritable Bowel Syndrome
- Chronic Bronchitis
- Asthma
- Chronic Allergies
- Cachexia or wasting syndrome
- Agitation related to Alzheimer’s Disease
- Any other diseases affecting the kidneys, liver, nervous system, or bladder.