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Medical Issues Questionnaire

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

Secured
Medical history questionnaire
1

Do you have any existing medical conditions?

Choose yes or no.
2

Rate your overall health from 1 to 5:

Rate your health on a scale from 1 (poor) to 5 (excellent).
3

If yes Please describe any medical issues you have:

Provide details about your medical issues.
4

Have u experienced any recent illness or injuries (within the past 6 months )?

Select one answer