You have a history nobody has read.
Most of it was never written down.
Some of it you never considered health information.
Before we start...
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Female
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I agree that Richmond Integrative & Functional Medicine may collect the health information I enter here and use it to build my Burden Map.
I have read the Burden Map Terms and Disclosures and the Privacy Notice.
Birth & infancy
Were you born by C-section?
Were you born more than three weeks early?
Did you spend time in newborn intensive care (NICU)?
As a child, did you have...
Strep throat more than once or twice
Infections that kept coming back
Pneumonia
Several rounds of antibiotics
Growing up, were you ever told you had…
Asthma
Eczema
Allergies — food, seasonal, or environmental
IBS or ongoing gut trouble
ADHD
Seizures, tics, or another neurological condition
Before you turned 18, did any of these happen?
A broken bone
A car accident
A concussion or hard blow to the head
Several seasons of contact sports
Adolescence
Did puberty start noticeably later for you than for your friends?
If you menstruate, or used to...
Irregular cycles
Unusually heavy bleeding
Painful periods
Have you ever had…
More cavities than most people
A tooth infection or abscess
Silver or metal fillings
A root canal
Bleeding gums or gum disease
Braces or a permanent retainer
Growing up, did you live…
Near a golf course
Near a Superfund site or known contaminated land
Near a dump or landfill
Within about a mile of a lake, river, or bay
Under or beside high-voltage transmission lines
Near a power plant
Near a major industrial site or industrial city
In a rural area or near a farm
Somewhere you saw crop dusting overhead
Growing up, was your home or school…
An apartment, condo, or shared building
Ever musty or damp-smelling
A school with visible mold or water damage
A household where someone smoked indoors
Built before about 1978
As a teenager, were you regularly around…
Solvents, fuel, paint, or cleaning chemicals at a job
Growing up, did you…
Mostly eat processed, canned, or boxed food
Eat fish you or your family caught
Eat game you or your family hunted
Drink well water at home
Travel
Have you traveled or lived in a developing country?
Did you get sick with stomach or gut trouble during or after travel abroad?
Serious injury
Have you had a serious injury that needed hospital care?
Have you had any of these removed or operated on?
Tonsils
Appendix
Gallbladder
Oral or jaw surgery, including wisdom teeth
Any other surgery
Have you ever…
Taken a prescription medication for more than a year straight
Taken antibiotics for months at a time for acne
COVID
Did you have COVID?
Did you get the COVID vaccine?
Did recovery from either take longer than two weeks?
In the past year, have you regularly had…
Headaches
A runny or stuffy nose
Nausea
Constipation or diarrhea
Stomach pain, gas, or bloating
Shortness of breath
Muscle aches
Aching or swollen joints
Skin rashes
Reactions to medications, supplements, foods, or smells
Sinus or chest congestion
And does that congestion come and go with the seasons?
Follow-Up
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