[restrict] Company Please describe your medical history, including injury, illness, accident, surgery, aches and pains. Include prescribed medications, dates, and treatment outcomes. Have you ever had a head injury or lost consciousness? Yes No Have you ever been diagnosed with Traumatic Brain Injury (TBI)? Yes No Describe your current medical health. Are you currently under a Doctor's care or being treated for any medical conditions? Yes No Please list the prescribed medications you are currently taking. Include the brand / generic name, dosage, frequency, since when and reason? Please list medications you are currently taking without a prescription. Please list dietary supplements you are currently taking without a prescription. Please list any federally illegal drugs you have used in the last 6 months. [/restrict]