Kids Juice Clinic Form Week 4

 
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1. First Name
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2. Last Name
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3. Study Number
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4. Did you keep a food record of what you ate yesterday?
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5. In the last week, on average, approximately how much time per day did you spend outside between 10 am and 4 pm?
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6. In the last week have you experienced any illness?
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7. In the last week have you taken ANY new medications or received any vaccinations or injections for any reason?
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8. In the last week have you taken any NEW dietary supplements?
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9. In the last week, have you used sunless tanning lotion or spent time in a tanning bed?
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10. Did you eat differently than usual this week?
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11. Was the amount or the type of your physical activity different than usual this week?
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