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Masonic Cancer Center - University of Minnesota · Pounds 33. Please darken the circles indicating the number of times since age 18 that you lost 20 or more pounds due to each of

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Page 1: Masonic Cancer Center - University of Minnesota · Pounds 33. Please darken the circles indicating the number of times since age 18 that you lost 20 or more pounds due to each of
Page 2: Masonic Cancer Center - University of Minnesota · Pounds 33. Please darken the circles indicating the number of times since age 18 that you lost 20 or more pounds due to each of
Page 3: Masonic Cancer Center - University of Minnesota · Pounds 33. Please darken the circles indicating the number of times since age 18 that you lost 20 or more pounds due to each of
Page 4: Masonic Cancer Center - University of Minnesota · Pounds 33. Please darken the circles indicating the number of times since age 18 that you lost 20 or more pounds due to each of
Page 5: Masonic Cancer Center - University of Minnesota · Pounds 33. Please darken the circles indicating the number of times since age 18 that you lost 20 or more pounds due to each of
Page 6: Masonic Cancer Center - University of Minnesota · Pounds 33. Please darken the circles indicating the number of times since age 18 that you lost 20 or more pounds due to each of
Page 7: Masonic Cancer Center - University of Minnesota · Pounds 33. Please darken the circles indicating the number of times since age 18 that you lost 20 or more pounds due to each of
Page 8: Masonic Cancer Center - University of Minnesota · Pounds 33. Please darken the circles indicating the number of times since age 18 that you lost 20 or more pounds due to each of

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