Syphilis Pre-Screening Form - StudySpec

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Syphilis Pre-Screening Form

Exploring innovative approaches for treatment and prevention.

Have you been diagnosed with syphilis in the past 6 months?

Are you currently undergoing treatment for syphilis?

Have you experienced any symptoms such as sores, rashes, or fatigue?

Full Name

Date of Birth

Gender

Contact Number

Email Address

Address

Height

Weight