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1. Do you or someone in your household have Diabetes?
2. Do you own a car?
3. Do you own or rent your primary residence?
4. Have you been diagnosed with Arthritis?
5. Do you or someone in your household have Asthma?
6. Do you or someone you care for currently have any of the following conditions? (Check all that apply)
7. Have you or someone you care for been diagnosed with either Lung or Pancreatic Cancer?
8. Have you or someone you care for been diagnosed with Epilepsy or experience Seizures?
9. Multiple Sclerosis affects millions of people. Please tell us how MS affects you:
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