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Osteoporosis Risk, Self Assessment
Personal Details
Please take the time to fill out the information below.
Name
Email
Age
Select an option
Male
Female
Have you ever fractured (broken) a bone:
Yes
No
If Yes, how many
Choose an option
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If Yes, were any of these fractures caused with minimal trauma?
Choose an option
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Has anyone in your family (parent or sibling) had fractures (broken bones) or been told that they have osteoporosis?
Yes
No
Have you had a fall in the last 12 months?
Yes
No
If Yes, how many?
Choose an option
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Have you ever had a bone mineral density test?
Yes
No
If Yes, were you diagnosed with:
Choose an option
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Height (cm):
Weight (kg):
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