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Numbness/Tingling- Right . Numbness/Tingling- Left . Numbness/Tingling- Both . Unable To Speak. Decreased Consciousness . Unsteadiness/Severe . Dizziness . Double Vision . One-Sided Weakness Previous treatments: (please give name of provider, date, type of treatment and if it helped) Name of provider, date, type of treatment Primary care provider ................
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