Heart Attack, Heart Murmur, Angina, Chest Pain, Stroke, Hypertension (High Blood Pressure), High Cholesterol Or Any Other Heart Or Blood Vessel Disorder?

Asthma, Bronchitis, Emphysema, Tuberculosis Or Any Other Lung Or Respiratory Disorder Or Sleep Apnoea Or Any Sleeping Disorder?

Depression, Anxiety, Panic Attacks, Stress (Requiring Advice From A Doctor Or Counsellor), Psychosis, Schizophrenia Or Any Other Mental Or Nervous Disorder?

Recurrent Indigestion, Hernia, Ulcer, Passing Of Blood From The Bowel, Vomiting Of Blood, Hepatitis (A, B, C Or D), Or Any Other Disorder Of The Liver, Gall Bladder, Intestines, Stomach Or Pancreas?

Cancer, Tumour, Skin Cancer, Skin Spot, Mole, Lump Or Growth Of Any Kind, Or Breast Lumps (Even If You Have Not Seen A Doctor)?

Any Impairment Of Sight Or Hearing Including Symptoms Such As Tinnitus Or Blurred Vision? (This Does Not Include Long Or Short Sightedness Corrected By Glasses Or Contact Lenses) ?

Back Pain, Neck Pain, Strain, Sciatica, Disorder Of The Spine Or Neck, Or Any Disorder Of The Joints, Muscles, Ligaments, Cartilage Or Limbs?

Arthritis, Gout, Osteoporosis, Fibromyalgia, Tendonitis, Tenosynotivits, Repetitive Strain Injury (Rsi) Or Any Inflammatory Disorder, Regional Pain Syndrome Or Chronic Fatigue?

Diabetes, Abnormal Blood Sugar, Thyroid Disorder Or Any Other Glandular Disorder?

Anaemia, Leukaemia, Haemophilia, Haemochoromatosis Or Any Other Blood Disorder?

Any Other Sickness, Injury, Physical Impairment, Procedure Or Syndrome Not Previously Mentioned?

Do You Take Any Medication On A Regular Basis (Other Than The Contraceptive Pill)?

Renal Colic or Kidney Stone, Blood in Urine Or Any Disorder Of The Kidneys, Bladder, Prostate or Reproductive Organs, abnormal Pap Smear or Mammogram?

Are You Currently Pregnant?