Diseases that run in the family (asthma, eczema, allergies, cancer, diabetes, rheumatism, etc.,). Mother, father, grandparents (father's and mother's side), children and siblings
Please list here what medications you take, for how long and how much (antibiotics, paracetamol, corticosteroids, birth control pill, creams, etc.).
Vaccinations as a child and later vaccines (related to travel, flu prevention, please include years, etc.)
Particulars before/during/after your own birth (e.g., mother's medication use during pregnancy, emotional events, childbirth initiation, pain management, etc.):
Smoking, alcohol, weed, or other drug use, per day or per week: