MEDICAL FORM USM 2025
Medical Form EN
Personal Data Protection Policy:
https://www.grupohpa.com/en/hpa-heath-group/personal-data-protection-policy/
PERSONAL DATA
1.
Please enter your date of birth
*
2.
Nationality
(Obrigatório.)
*
3.
Name
(Obrigatório.)
MEDICAL FORM
4.
Describe the medication you usually take:
*
5.
Diabetes?
(Obrigatório.)
Yes
No
6.
If you have Allergy(s) (Drugs, Food and/or other(s)) please describe:
*
7.
Respiratory disease?
(Obrigatório.)
Yes
No
If yes, which one?
*
8.
Epilepsy?
(Obrigatório.)
Yes
No
*
9.
High Blood Pressure?
(Obrigatório.)
Yes
No
*
10.
Heart Disease?
(Obrigatório.)
Yes
No
If yes, which one?
*
11.
Have you had any major injuries since 2025?
(Obrigatório.)
Yes
No
