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Additional required information
Do you suffer from a Chronic Condition?*
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Alcohol Abuse
Alzheimer's Disease and Related Dementia
Arthritis (Osteoarthritis and Rheumatoid)
Asthma
Artial Fibrillation
Autism Spectrum Disorders
Cancer (Breast, Colorectal, Lung, and Prostate)
Chronic Kidney Disease
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Hepatitis (Chronic Viral B & C)
HIV/ AIDS
Hyperlipidemia (High cholesterol)
Hypertension (High blood pressure)
Ischemic Heart Disease
Osteoporosis
Schizophrenia and Other Psychotic Disorders
Stroke
Do you have a primary Care Physician?*
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What is your Primary Care Physicians name?*
Best time for a heathcare professional to call and go over the details of the program?
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9AM - 11AM EST
11AM - 1PM EST
1PM - 3PM EST
3PM - 5PM EST
5PM - 8PM EST
*required information