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Name:
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Birthday:
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Address:
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Email Address:
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Male Reproductive
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At what age did you notice testicular and penile growth?
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Have you ever had a hernia?
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Have you ever noticed any testicular masses?
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Have you experienced testicular pain?
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Are you sexually active?
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Have you ever had a sexually transmitted disease?
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Have you ever noticed any penile discharge?
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What is your sexual preference?
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