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1
Name
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First Name
Last Name
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2
Email
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example@example.com
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3
How many different medications are taken daily?
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4
How often do you take each medication?
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5
Is this for you or a loved one?
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Myself
Loved one
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6
What is the primary health condition? (*We ask this to check for time sensetive conditions like Parkinson's)
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7
Would the user like live call reminders when it's time to take medication?
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YES
NO
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8
Anything else you'd like us to know?
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