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Health Assessment and Management Questionnaires

Health Assessment Questionnaire
About You - Step 1 of 7

1. About You

Please complete all fields.
Height in Meters
Weight in Kg
Waist Size in Centimeters
Is there a family history of any of the following: Heart and circulatory disease, heart attack, heart failure, atrial fibrillation, stroke? (immediate family members i.e Grandparents, parents, brothers, sisters)
Health Management Club
About You - Step 1 of 6

1. About You

Height in Meters
Weight in Kg
Waist Size in Centimeters
Please give the current age and state of health of the following relatives, or if deceased, their age and the cause of death Is there a family history of any of the following (Grandparents, parents, brothers, sisters)? If appropriate please provide details.