Jessica Taylor
jess.taylor@example.com 021 678 9012
29/29 questions
Residence & Citizenship
Country of residence NZ
Citizenship status nz-citizen
Measurements
Height 163
Weight 55
Health & Lifestyle
Questions and declarations
Cancer No
Diabetes No
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
Alcohol consumption No
Drug use No
HIV status No
Travel plans No
Other medical conditions No
Family history Yes
— Which of these conditions was your parent, brother or sister diagnosed with prior to age 60? Diabetes
— Have 2 or more family members (a parent, brother or sister) had diabetes before aged 60? No
Risky occupations None of these
Recreational activities None of these
Post-Review Details
Additional information provided
List your family members that suffered Heart, Kidney, Parkinson's, Huntington's or Motor Neurone Disease or Cancer, Stroke, Diabetes, MS, Muscular Dystrophy or Familial polyposis, including age diagnosed/died and/or current health. Mother diagnosed with Type 2 diabetes at age 55.
Please provide details for each condition. Mother manages condition with diet and Metformin. No other family members affected.