| 1. Did your mother or father have a history of spinal problems? |
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| 2. Have you or any of your immediate family been diagnosed with osteoporosis? |
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| 3. Have you ever had any trauma to your head, neck, or back (concussions, car accidents, falls)? |
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| 4a. Have you ever had any spine surgery? |
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| 4b. Was it a Fusion Surgery? |
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| 5. Due to the constraints of your job duty, are you unable to change positions in your work place OR do you do repetitive or heavy physical activities on the job daily? (Twisting, turning, bending, overhead work, lift greater than 50 pounds frequently, assembly line). |
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| 6. Do you spend more than half your regular work day sitting? |
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| 7. Do you have a history of smoking or do you use any other form of tobacco? |
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| 8. Do you participate in any high impact or high velocity activities (contact sports, skiing)? |
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| 9. Are you overweight? |
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| 10. Do you exercise and eat well on a regular basis? |
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