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My Identity

Marital satus:
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First name
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Last name
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Country
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Identity of the tested person

First name
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Last name
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Birthdate
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Sex:
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Has the tested person been diagnosed with EHS?
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If so, on which date?
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Has the tested person implemented methods to protect himself/herself from electromagnetic waves (in the last 6 months)?
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If yes, which ones ?
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Has the tested person been treated with, for example, chlorella, milk thistle, green clay or activated charcoal (in the last 6 months)?
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Environmental questions

 

INDOOR
Do you have this type of material:

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OUTDOOR
Do you live at a distance of less than 1000 m from:

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Health questions

 
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