Download - you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No

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Page 1: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 2: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 3: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 4: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 5: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 6: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 7: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 8: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No

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