John Smith
john.smith@example.com 021 123 4567
18/26 questions
Residence & Citizenship
Country of residence NZ
Citizenship status nz-citizen
Measurements
Height 178
Weight 82
Health & Lifestyle
Questions and declarations
Cancer No
Diabetes Yes
— Have you ever had any complications from diabetes such as ulcers, kidney disease, eye problems, cardiovascular problems, diabetic coma, stroke or transient ischaemic attack? No
— What type of diabetes was diagnosed? type-2
Blood disorder No
High blood pressure No
High cholesterol No
Heart or vascular problems No
Digestive problems No
Kidney or bladder problems No
Breathing or lung problems No
Neurological disorder No
Musculoskeletal problems No
Mental health No