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Have the police caught you driving dangerously?
Have you had your license suspended or revoked, or had more than one ticket or accident in the past 5 years?
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Are you a smoker?
Within the past 5 years have you used tobacco or nicotine in any form (cigarettes, e-cig/vape, cigars, smokeless chewing tobacco, pipe, etc)?
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Ever treated for any of following?
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