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Medical History
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Have you been diagnosed with any of the following (check all that apply):
Major depression (MDD)
Bipolar disorder
Generalized anxiety disorder (GAD)
Obsessive-compulsive disorder (OCD)
Post-traumatic stress disorder (PTSD)
Schizophrenia
Alzheimer's disease
Traumatic brain injury
Hypertension (high blood pressure)
Diabetes
Heart attack
Stroke
Seizures
Other
Other diagnoses:
Are you taking medication for depression?
Yes
No
List the name and dose of your depression medication:
Are you taking medication for schizophrenia?
Yes
No
List the name and dose of your schizophrenia medication:
Do you use cannabis (marijuana)? (Some studies allow for some use of cannabis)
Yes
No
Do you think you would pass a drug screen?
Yes
No
Not Sure
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