2. If you answered yes to the above question, how many times did that
particular problem occur and when did it happen?
3. Were you on any form of conditioning program during the summer? If
the answer is yes, briefly explain your program.
4. Did you work in an air-conditioned building during the summer?
5. Are you presently on a diet? If yes, what kind of diet? Who designed
it?
6. Have you been restricting your water intake for any reason? If yes,
explain why.
7. Have you recently (last 2 weeks) had a cold, problem with vomiting,
or diarrhea? If yes, please explain.
8. Are you currently on any medication? If yes, list the name and/or
purpose of the medication.
Name
Date