| Have you had any operations or been admitted to hospital in the last 12 months? | |
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| What is your date of birth? | |
| What is your blood pressure? | |
| What is your height? | |
| What is your weight? | |
| Do you smoke, drink alcohol or use any recreation drugs? | |
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| Are you experiencing any of the following symptoms; fever, headaches, chills, visual changes, feeling weak, seizures, nausea, vomiting, difficulty breathing, increased heart rate, increased breathing rate, abdominal pain and diarrhoea? | |
| Do you suffer from any allergies? | |
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| Is there any medical conditions that run in your family? (e.g, Diabetes, Hypertension, Coronary heart disease). | |
| |
| Have you been clinically diagnosed with any medical condition? | |
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