1. Are you currently being treated by a healthcare professional for this condition?
2. When were you diagnosed for this condition ?
3. Have you been prescribed any medication for this condition ?
4. If yes, describe your medications:
5. Are you experiencing any symptoms from your condition?
6. Have you recently had lab work to confirm your diagnosis?
7. If yes, please email to , fax to (423) 477-3164, or upload the file here:
8. Have you ever been diagnosed with (check all that apply):