Please complete your Health QuestionnaireIan Evans2022-10-16T18:57:27+00:00 Please complete your Health Questionnaire "*" indicates required fields Step 1: Please advise if any of the listed conditions are applicable to you* You have a pacemaker You are pregnant You currently have an acute disease, bacterial infection or inflammatory disease that could result in inflamed heart muscles or bacteria reaching the heart You have recently undergone an operation that is less than 8 weeks old You have thrombosis or thrombophlebitis You have a stent or bypass that has been active for less than 6 months You have arteriosclerosis and arterial circulatory problems You have untreated high blood pressure You have cardiac arrythmia You have any bleeding disorder You have any known cancers or tumours You have epilepsy (and had a seizure in the last 12 months) You have an abdominal wall hernia or inguinal hernia You have any diseases that effect the internal organs, particularly the kidneys You have had metals such as (copper, stainless steel and titanium) implanted, surgically or other in the last 8 weeks Yes, I have one or more conditions. No, I don't have any of these conditions. Do any of the following apply to your current state of health?Please select all that apply. You have a pacemaker You are pregnant You currently have an acute disease, bacterial infection or inflammatory disease that could result in inflamed heart muscles or bacteria reaching the heart You have recently undergone an operation that is less than 8 weeks old You have thrombosis or thrombophlebitis You have a stent or bypass that has been active for less than 6 months You have arteriosclerosis and arterial circulatory problems You have untreated high blood pressure You have cardiac arrythmia You have any bleeding disorder You have any known cancers or tumours You have epilepsy (and had a seizure in the last 12 months) You have an abdominal wall hernia or inguinal hernia You have any diseases that effect the internal organs, particularly the kidneys You have had metals such as (copper, stainless steel and titanium) implanted, surgically or other in the last 8 weeks Please list any other medical conditions in the box below that are not listed above. These can be such things as eczema, sunburn, medication, arthritis, acute or chronic back pain, open wounds or skin irritants.List below:Confirmation:*I confirm that the health information supplied is a true and accurate for within the last 12 months. Yes, I confirm this is a true reflection of my recent health.
