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Medical Health Questionnaire

Have you ever been told you have had any of the following treatments, conditions or diseases?#

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High blood pressure/hypertensionQuestionsArtificial jointQuestions
Kidney diseaseQuestionsAsthmaQuestions
Angina/chest painQuestionsSexually transmitted diseaseQuestions
Organ/cell transplantQuestionsDiabetes mellitusQuestions
Heart attack (myocardial infarction)QuestionsAIDS/HIV diseaseQuestions
CancerQuestionsThyroid disorderQuestions
Prosthetic heart valveQuestionsTuberculosisQuestions
Radiation therapyQuestionsAutoimmune disorderQuestions
Irregular heartbeat (arrhythmia)QuestionsPsychiatric disorderQuestions
ChemotherapyQuestionsLiver diseaseQuestions
Pacemaker/defibrillatorQuestionsEating disorderQuestions
Epilepsy/seizureQuestionsHepatitis, ViralQuestions
Congestive heart failureQuestionsAllergiesQuestions
Stomach/intestinal disordersQuestionsAnemiaQuestions
Stroke/TIAQuestionsPregnancyQuestions
ArthritisQuestionsBleeding disorderQuestions
Emphysema/bronchitisQuestionsOsteoporosisQuestions

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