Health form

Your name(Obligatoriskt)
Do you smoke?(Obligatoriskt)
Do you have high blood pressure?(Obligatoriskt)
Do you have epilepsi?(Obligatoriskt)
Do you have diabetes?(Obligatoriskt)
Do you have any heart and cardiovascular disease?(Obligatoriskt)
Do you take any medication? (For example blood thinning medicine)(Obligatoriskt)
Are you allergic to any medication? (for example antibiotics)(Obligatoriskt)
Do you have a blood infection? (for example Hepatitis B/C or HIV)(Obligatoriskt)
Today's date(Obligatoriskt)