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The purpose of this questionnaire is to help identify health problems you may be having and to understand your responses to various exposures. Complete all five sections describing how you are now.

If your health problems began suddenly or became much worse after a particular exposure event, such as a pesticide exposure or moving to a new home or office building, then complete sections 1-3 a second time to indicate how you were before the exposure event. A link to provide 'before exposure event' information will be shown next to the Symptom Star on your report.