| Condition | Yes | No | Please Describe |
| Reflux? | |||
| Breathing issues e.g., Snoring? | |||
| Sleep Apnoea? | |||
| Allergies? | |||
| Constipation? | |||
| Epilepsy/Seizures? | |||
| Ongoing Pain? | |||
| Temperature regulation issues (e.g., excessive sweating, or cold extremities) | |||
| Any other health conditions? |
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