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  • Alcohol Abuse
  • Drug Abuse or Addiction
  • Alzheimer's
  • Cancer
  • Crohn's Disease
  • Emphysema
  • Gout
  • HIV
  • Lupus
  • Pain (Chronic & Ongoing)
  • Sarcoidosis
  • Vascular Disease
  • Anxiety, ADD or ADHD
  • Gastric/Peptic Ulcers
  • Artery (Coronary) Disease
  • Colitis or Ileitis
  • Depression or Mental Illness
  • Epilepsy
  • Heart Disease or Abnormal EKG
  • Hypothyroidism (low thyroid)
  • Mitral Valve Prolapse
  • Parkinson's Disease
  • Sleep Apnea
  • Currently Pregnant
  • Asthma
  • Recurrent Kidney Stones
  • Arthritis (Psoriatic or Rheumatoid)
  • COPD
  • Fibromyalgia
  • Diabetes
  • Hepatitis or Liver Disease
  • Kidney Disease
  • Multiple Sclerosis
  • Prostate Issues (no cancer)
  • Stroke
 I confirm that I have no illnesses listed above.
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Annual Income Range 

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