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you are currently taking, how long have you
been taking them, what is it prescribed for
and how often are you taking them.
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Do You Smoke?
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more than one pack day
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less than one pack a day
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I quite more than one year ago
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I quite less than one year ago
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Type of Insurance:
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Currently Insured?
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Amount of Coverage Desired:
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1,000,000
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