Health & Medical Information

Personal Information:

Health & Medical Information

Regarding each stress-coping category listed below, rate your frequency of participation in the listed areas:
Below, please prove the requested information regarding your most recent high-risk activity for contracting HIV or STD.

High-risk activities include: blood contact, sexual contact of any kind (with or without a condom), intravenous drug use, international travel in which you have received any form of medical care.

For Women Only

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