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A few questions to further customize your experience

Your Health

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  1. Do you (or a loved one) have any of the following conditions?*
  2. Do you have medicare?*

Tell Us More About You

  1. Millions of people in the US treat their pain with medications such as Hydrocodone, Oxycodone, or Morphine that contain Opiods. Are you currently treating your pain with similar medications?*
  2. Have you been diagnosed with Inflammatory Bowel Disease?*
  3. Do you experience sudden and frequent urges to “go”, leaking or repeat bathroom visits?*
  4. Have you or a loved one been injured in a car accident within the last 3 years?*
  5. Are you 40 years old or older?*

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