APTA members may download and adapt this form only for …

- Having trouble falling asleep - Eating too much or too little ... (hand, arm, leg) for Memory loss. no apparent physical reason Stutters severly, mumbles or cannot speak at all ... Inability to fall asleep or stay asleep Withdrawal from social or recreational activities Uncharacteristic outbursts of rage or panic Nightmares or memories that ... ................
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