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Have you been hospitalized in the last 5 years?
Do you currently take prescription medications?
Have you ever been treated for any of the following: Cancer, High Blood Pressure, Diabetes, Asthma, Immune System Disorders, Depression/Anxiety, Heart Disease, Drug/Alcohol Abuse, Epilepsy, or similar health conditions?
Have any of your immediate family members (parents or siblings) had: Cancer, heart disease, stroke or an aneurism prior to the age of 70?
Did they pass away from these causes prior to age 70?
Are you currently insured?
 
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