Do you feel generally run-down and tired?
True		False

Do you have a bad cough?
True		False

Are you bleeding from your orifices?
True		False

Are you running a temperature?
True		False

Is your cholesterol high?
True		False

Do you suffer from tremors?
True		False

Have you found a mysterious lump?
True		False

Have you traveled in the Third World lately?
True		False

Have you had unprotected sex?
True		False

Do you feel you are losing your mind?
True		False

Have you lost your appetite?
True		False

Are you out of shape?
True		False

Have you ever used IV drugs?
True		False

Are you experiencing motor control problems?
True		False

Have you lost weight without dieting?
True		False

Are your limbs stiff?
True		False