| Did the Patient's mother live near high-voltage power lines or electromagnetic fields during time of pregnancy? | 0 | 0 | 0 |
| Did the Patient's mother live in an agriculture region during pregnancy? | 0 | 0 | 0 |
| Did the Patient's mother live near a toxic or hazardous waste site during childhood? | 0 | 0 | 0 |
| Did the Patient's father live near a toxic or hazardous waste site during childhood? | 0 | 0 | 0 |
| Did the Patient's mother live near an airport during pregnancy? | 0 | 0 | 0 |
| Did the Patient's mother have any Chemical exposures from hobbies, work, or home? | 0 | 0 | 0 |
| Did either of the Patient's parents live near a factory growing up or at the time of conception of your child? | 0 | 0 | 0 |
| Did the Patient's mother live near a factory during your pregnancy? | 0 | 0 | 0 |
| Have either of the Patient's parents or grandparents been struck by lightning or electrocuted? | 0 | 0 | 0 |
| Have either of the Patient's parents lived near a toxic waste or medical waste incinerator? | 0 | 0 | 0 |
