1 [] Weight loss/ loss of appetite
1 [] Change in bowel or bladder habits
1 [] Unusual bleeding or discharge
1 [] Lump in breast or elsewhere
1 [] Indigestion
1 [] Difficulty in swallowing
1 [] Change in a wart or mole
1 [] Nagging cough or hoarseness
1 [] Chest pain
1 [] Shortness of breath
1 [] Sores that don't heal
1 [] Tired/fatigued
1 [] Changes on skin/rash/blemish/sunspots/blotches
1 [] Other (Specify) ____
1 [] DK