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Cough Cold and Flu
This form will help us in deciding what to suggest to you for your symptoms
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Email
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Your email
How old is the person that this product is for?
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Your answer
Please select all the relevant symptoms that apply.
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Cough
Runny nose or blocked nose
Joint Pain
Headache
Fever
Itchy eyes
Other:
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If you have a cough, please select one of the following to describe your cough
Dry, tickly throat cough
Cough producing mucus
Cough that isn't producing mucus but a heavy chest
Other:
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Do you have any allergies? Please specify allergies if you do.
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Your answer
What medication, if any, do you take?
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Your answer
What medical conditions, if any, do you have?
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Your answer
Are there any other symptoms that you are currently experiencing?
Your answer
Is there any thing else that you would like us to know about?
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