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In order to better match you with the appropriate study, we would like to know a little more about your overall medical health and history. Please provide as much information as you can in the following fields. Per CKRA’s privacy policy, all of your personal information that we have obtained will be kept in our secure database, which can only be accessed by authorized CKRA personnel, unless given your permission or except as required by law.

Medical History (Diagnosis, Surgeries, Illnesses, Allergies, etc.)

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