Please Answer the Following Questions:

Do you have:
Any body piercings that cannot be removed Yes No
Tattoos around or above the neck Yes No
Pacemaker, joint replacement, bullet, shrapnel, artificial limbs, pins, or screws Yes No
Have you ever been diagnosed or treated for:
MS or seizures of any kind Yes No
Major Depression Yes No
Schizophrenia, Schizoaffective Disorder, Psychosis Yes No
Substance Abuse Yes No
Bipolar Disorder Yes No
Aspergers/Autism Yes No

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