1. Cover for pre-existing conditions Clinical Intelligence Questioning for Brokers & Distributors to open the tool, click to the next page… CQI

2. How to use your – “Clinical Intelligence Questioning” Tool This screen is your “Homepage”, to return to this page at anytime click the top of the CIQ Logo in the top left hand corner of any page. Clicking on the CIQ letters will take you to the next page. By clicking on the 1 st letter of the condition from the alpha sequence below, you will be taken to a list of conditions. Click on the relevant condition that applies to your customer and you will be taken to the specific additional questions required to underwrite your customer. REMEMBER! These questions are required in ADDITION to the standard questions under section 7 of the Application Form. abcdefghijklmnopqrst uvwxyz Useful Reference Materials & Forms Yellow “Speech Bubbles” within CIQ alert you to critical information or action required C QI Decline List

3. Useful Reference Materials & Forms C QI CANCER Click on symbol to be taken to the Cancer Statement to be printed and completed by the Dr who has treated the client. DIABETES Click on symbol to be taken to the Diabetes Statement to be printed and completed by the Dr who has treated the client. CARDIAC ARRHYTHMIA Click on symbol to be taken to the Cardiac Statement to be printed and completed by the Dr who has treated the client.

4. A – D Conditions Adenoiditis (Adenoidectomy) Allergic Rhinitis / Hayfever Atrial Fibrillation (AF) Benign Prostatic Hyperplasia (BPH)Benign Prostatic Hyperplasia (BPH) Cataract Colonic Polyps Contact Dermatitis / Eczema Diabetes Mellitus – Type 2 Diverticular Disease Cholesterol (High) Detached Retina / Retinal Detachment Click on the condition to access the questions you need to ask your client: - C QI ACL – Anterior Cruciate Ligament Cancer Cold Sores (caused by Herpes Simplex) Asthma Acne Acid reflux (Reflux Oesophagitis) Ankle / Foot Sprain / Strain Celiac/Coeliac Disease Back Pain Breast Lump (non cystic ) / Fibroadenoma

5. Decline List Asbestosis Cerebral Palsy CQI Alzheimer’s Disease Amyotrophic Lateral Sclerosis Addison Disease Chronic Constrictive Pericarditis Acromegaly Ankylosing Spondylitis Chronic Renal Insufficiency Cor Pulmonale Creutzfeld-Jacob Disease Cystic Fibrosis Diabetes Insipidus Down’s Syndrome Dwarfism of pituitary cause Dialysis treatment Fancon’s Anaemia Felty’s Syndrome Fibrocystic Disease of the Pancreas/Mucoviscidosis Fibromalgia Fiedrich’s Ataxia Galactosemia Gardner’s Syndrome Granuloma Eosinophile Hemochromatosis (diagnosis of) Haemophilia A & B Interstitial Pulmonary Fibrosis Klinefelter Syndrome Liver Cirrhosis Lupus Erythematosus Metastic Cancer Mixed Connective Tissue Disorder Morbid Obesity Multiple Myelomas Multiple Sclerosis Organ Transplant (status post, except for cornea transplant) Paget’s Disease (Osteodystrophia Deformans) Parkinson’s Disease Pemphigus Vulgaris Pariartheritis Nodosa Pneumoconiosis Polycystic Renal Disease Polycytemia Polymyositis Porphyria Quadriplegia Reiter’s Syndrome Schizophrenia Scleroderma/Progressive Systematic Sclerosis (PSS) Sebastian Syndrome Silicosis of the lungs Tetraplegia Thalassemia Major Turner’s Syndrome Von Recklinghausen’s Disease Wegener’s Granulomatosis

6. E – H Conditions Eczema / Contact Dermatitis Epilepsy / Seizures Fibrocystic Breast Disease Fibroids Haemorrhoids / Piles Gall Stones Gastritis Genital Herpes Glaucoma Gout Hayfever / Allergic Rhinitis Hiatus Hernia High Cholesterol Hypertension (High Blood Pressure) Hyperthyroidism (Over active Thyroid) Hypothyroidism (Under active Thyroid) C QI Hepatitis A Click on the condition to access the questions you need to ask your client: - Herpes Simplex (other than cold sore) Heartburn (Reflux Oesophagitis) Herpes Zoster / Shingles Foot / Ankle Sprain / Strain Fungal Infections – external Fibroadenoma / Breast Lump Helicobacter Pylori

7. I – L Conditions Impaired Glucose Tolerance / Pre-Diabetes IBS – Irritable Bowel Syndrome Kidney or Ureter Stones (Calculus) C QI Click on the condition to access the questions you need to ask your client: - Inguinal Hernia Knee Sprain (ligament) other than ACL Knee Strain Leg Sprain / Strain Knee Disorders: ACL – Anterior Cruciate Ligament Meniscal Tears Rupture of knees

8. M – P Conditions Malaria Migraine Meniscal Tears Moles Osteoarthritis Osteoporosis Peptic Ulcer Disease Psoriasis C QI Click on the condition to access the questions you need to ask your client: - Otitis Media Palpitations Paroxysmal Atrial Fibrillation Ovarian Cyst

9. Q – T Conditions Reflux Oesophagitis (without hiatus hernia)Reflux Oesophagitis (without hiatus hernia) Retinal Detachment / Detached Retina Rotator Cuff Injury Rupture of knees Sebaceous Cyst C QI Shingles / Herpes Zoster Click on the condition to access the questions you need to ask your client: - Supra Ventricular Tachycardia (SVT) Tonsillitis (Tonsillectomy)Tonsillitis (Tonsillectomy) Thyroid Disorders Sinusitis Shoulder Sprain / Strain

10. Thyroid Disorders Hypothyroidism – Under active C QI Click on the condition to access the questions you need to ask your client: - Hyperthyroidism – Over active Other thyroid conditions – No loadings currently availableOther thyroid conditions – No loadings currently available

11. U – Z Conditions C QI Click on the condition to access the questions you need to ask your client: - Urinary Tract Infection Urinary Tract Infection

12. Specific Cancers Bladder Cancer Basal Cell Carcinoma Bone Cancer Brain Cancer Colorectal Cancer Kidney Cancer Leukaemia Liver Cancer Lung Cancer C QI Breast Cancer Ovarian Cancer Oesophageal Cancer Pancreatic Cancer Prostate Cancer Stomach Cancer Uterine Cancer Squameous cell carcinoma Melanoma Non – Hodgkin's Lymphoma Click on the condition to access the questions you need to ask your client: - Remember, in cases where the client has been symptom and treatment free for the required time, click the cancer symbol to be taken to the “Cancer Statement”. Unlisted Cancer

13. ACL – Anterior Cruciate Ligament Which knee is affected? Have you had an operation on the knee? If so, when (month and year) Do you have any ongoing symptoms or problems? C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

14. Knee sprain (ligament) other than ACL Which knee is affected? Have you had an operation on the knee? If so, when (month and year) Do you have any ongoing symptoms or problems? C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

15. Knee Strain Which knee is affected? Have you had an operation on the knee? If so, when (month and year) Do you have any ongoing symptoms or problems? C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

16. Leg Sprain / Strain Which leg is affected? Have you had an operation on the leg? If so, when (month and year) Do you have any ongoing symptoms or problems? C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

17. Ankle / Foot Sprain / Strain Which ankle/foot is affected? Have you had an operation on the ankle/foot? If so, when (month and year) Do you have any ongoing symptoms or problems? C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

18. Acne How long have you been suffering from acne? Is your acne caused by any other condition? E.g. hormone imbalance What treatment has been given – now or in the past? Please provide start and stop dates for treatment (month and year) C QI This condition refers to Question 6 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

19. Allergic Rhinitis / Hayfever When did you first have symptoms? Do you take any regular medication? If so, what do you take and how often? C QI This condition refers to Question 3 of the Confidential Medical History. Do you know what causes your Hayfever or allergic rhinitis? (e.g. dust, grass, pollen) Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

20. Sinusitis When did you last have symptoms? How many episodes of sinusitis have you had? C QI This condition refers to Question 3 of the Confidential Medical History. Have you been advised that you may need surgery? Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

21. Asthma How long have you had asthma? Have you ever been admitted to hospital for your asthma? Do you take or have you taken any medication, either now or in the past? Please provide dates (month and year) C QI This condition refers to Question 3 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

22. BPH – Benign Prostatic Hyperplasia Have you had an operation for your Benign Prostatic Hyperplasia? What was the name of the procedure that was carried out, and when did you have it? (Month and year) C QI This condition refers to Question 9 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here. Please provide details of your last PSA test result including date of test.

23. Breast Cancer C QI This condition refers to Question 5 of the Medical History. Have you been symptom and treatment free from your cancer for more than 10 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

24. Cataract Which eye do you have / did you have the cataract in (or is it both)? Have you had any surgery for your cataract(s)? Which eye was operated (or was it in both). When did the operation take place? (month and year) Do you have any treatment planned or expected? Which eye is it for (or is it for both)? C QI This condition refers to Question 11 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

25. Colonic Polyps When were symptoms first noticed? (month and year) Have you had any investigations or received any treatment? E.g. colonoscopy and polyp removal? If so, when? (month and year) Do you have any further treatment planned or expected? C QI This condition refers to Question 4 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

26. Ovarian Cyst Is the member in question postmenopausal? Is the cyst present? If so, please provide details of treatment planned or expected. Have you suffered from previous cysts? How were each treated and when did you experience these? C QI This condition refers to Question 9 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here. Is there any underlying cause to the cyst/s, such as Endometriosis or Polycystic Ovaries?

27. Contact Dermatitis / Eczema When were symptoms first noticed? (month and year) C QI This condition refers to Question 6 of the Medical History. Have you received any treatment? If yes, what treatment did you receive and when? (month and year) Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

28. Diabetes Mellitus – Type 2 C QI This condition refers to Question 2 of the Medical History. Please ask the client’s Dr to complete Diabetes Medical Statement. – Click the Diabetes Symbol below for a copy:

29. Diverticular Disease When were you diagnosed? (month and year) How were you diagnosed? What symptoms have you had in the past? What current symptoms do you have? Do you have any treatment planned or expected? C QI This condition refers to Question 4 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

30. Epilepsy Have you had a seizure in the last 2 years? What medication(s) do you take? Is the epilepsy controlled by more than 1 type of medication? Is the epilepsy secondary to another condition? C QI This condition refers to Question 7 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

31. Fibrocystic Breast Disease C QI This condition refers to Question 5 or 6 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form.

32. Fibroadenoma / Breast Lump (non cystic) C QI This condition refers to Question 5 or 6 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form.

33. Fibroids Do you currently have fibroids or any symptoms? Are you currently receiving any treatment, or are you taking any medication? Do you expect to have any treatment? What treatment, if any, has been given in the past? Please provide dates of treatment. (month and year) C QI This condition refers to Question 9 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

34. Gall Stones Do you have current symptoms? Have you had any surgery - e.g. removal of gall bladder? If so, when (month and year)? Do you have any treatment planned or expected? C QI This condition refers to Question 4 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

35. Gastritis C QI This condition refers to Question 4 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here. What, if any, investigations have been carried out? Please include details of results and confirmation of a final diagnosis/underlying cause, if known. If a diagnosis has not been made, what (in your treating Dr’s opinion) was the suspected cause of the gastritis? What symptoms, both current and previous have you experienced? Please include dates (month and year) What treatment has been received to date? Please include details of any medication. Is there any ongoing treatment or follow-up planned?

36. Helicobacter Pylori C QI This condition refers to Question 4 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form.

37. Genital Herpes When were the symptoms first noticed? (month and year) What treatment has been received to date? Include stop and start dates of treatment (month and year) Is any treatment planned or expected? C QI This condition refers to Question 6 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

38. Glaucoma When was glaucoma diagnosed (month and year)? Have you had any surgery? If so, what type of surgery did you have and when did you have it (month and year)? Do you have any further treatment planned or expected? C QI This condition refers to Question 11 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

39. Gout Does your gout affect your heart or kidneys? If yes, please provide details When was the last time you had an acute attack (month and year)? Are you currently taking or have you taken any medication in the last 2 years? Are you currently receiving any treatment? Do you have any treatment planned? C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

40. Haemorrhoids / Piles Have you had any symptoms or received any treatment in the last 3 years? What treatment have you receive? (eg banding, injecting) When did you receive it (month and year)? Do you have any current symptoms? C QI This condition refers to Question 4 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

41. Hiatus Hernia When were you diagnosed with hiatus hernia (month and year)? Have you had any surgery? If yes, when was the surgery (month and year)? Do you have any current symptoms? Are you having any treatment, or do you have treatment planned? C QI This condition refers to Question 4 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

42. High Cholesterol When were you diagnosed with high cholesterol (month and year)? Are you taking any medication now or have you taken any in the past? If so, what medication did you / are you taking Do you have any further treatment planned? This condition refers to Question 10 of the Medical History. C QI Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

43. Hypertension When were you diagnosed with high blood pressure (month and year)? Have you ever been admitted to hospital because of your high blood pressure? If so when, and how long for? Are you currently on any medication or have you been on medication in the past? If you are currently taking medication – what medication did you take / are you taking? C QI This condition refers to Question 1 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

44. Hyperthyroidism Have you had any symptoms or treatment in the last 3 years? What medication do you currently take? Do you have any further treatment or any surgery planned? C QI This condition refers to Question 2 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

45. Hypothyroidism When were you diagnosed with an underactive thyroid (month and year)? Have you had any surgery to remove your thyroid gland? If so, what was the reason for the surgery and when did you have it (month and year)? What medication have you taken in the past? What medication are you currently taking? C QI This condition refers to Question 2 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

46. IBS / Irritable Bowel Syndrome C QI This condition refers to Question 4 of the Medical History. Have you had any symptoms, treatment or consultations in the last 2 years? If so, please provide full details, including names of medication, start and stop dates of treatment (month and year). Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

47. Inguinal Hernia C QI This condition refers to Question 4 of the Medical History. What treatment have you received in the past? Please include dates of treatment (month and year). Do you have any further treatment expected or planned? Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here. Which side was your hernia located (or was it both). Have you had a reoccurrence of your hernia?

48. Kidney or Ureter Stones (Calculus) C QI This condition refers to Question 9 of the Medical History. Have you had symptoms or treatment in the last 5 years? Please provide full details, including type of treatment and dates of treatment (month and year). Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

49. Malaria Are you currently receiving treatment for malaria? What symptoms or treatment have you had in the last year? Do you suffer from any complications of a malaria infection? C QI This condition refers to Question 10 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

50. Malignant Melanoma C QI This condition refers to Question 5 of the Medical History. Have you been symptom and treatment free from your cancer for more than 10 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

51. Migraine C QI This condition refers to Question 7 of the Medical History. Are you currently taking any medication? Have you taken any medication in the past? Please give full details of the types and frequency of the medication. When was the last time you took medication (month and year)? Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

52. Meniscal Tears Which knee is affected – or are both affected? Have you had surgery to the affected knee(s). If so, what surgery have you had? When did you have surgery (month and year)? Do you have any current symptoms? Do you have any treatment planned or expected? C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

53. Moles Have you ever had mole mapping? Have you ever had a benign mole or moles removed? Please give details including dates of treatment (month and year)? Have you ever been diagnosed with dysplastic naevi syndrome? C QI This condition refers to Question 6 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

54. Non-Hodgkin's Lymphoma C QI This condition refers to Question 5 of the Medical History. Have you been symptom and treatment free from your cancer for more than 10 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

55. Osteoarthritis Which joint or joints are affected? Please include left, right or both. Have you had any surgery? Please provide full details including name of procedure, which joint and when (month and year). If you have had surgery have you had metal on metal hip replacement or hip resurfacing? C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

56. Osteoporosis Have you suffered any fractured bones? If so, please provide full details including method of treatment (cast / surgery), date of treatment (month and year) and which bone was fractured (include left / right / both) C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here. If you have had surgery: Did you have any internal / external fixation? If yes, when was the fixation removed (month and year), or does it remain in place?

57. Otitis Media Have you had any treatment or symptoms in the last 2 years? C QI This condition refers to Question 11 of the Medical History. If yes, please provide full details including, treatment received and dates (month and year). Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

58. Peptic Ulcer Disease Is the ulcer still present? If not, when did you last experience symptoms or have any treatment (month and year)? C QI This condition refers to Question 4 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

59. Psoriasis C QI This condition refers to Question 6 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form.

60. Celiac/Coeliac Disease C QI This condition refers to Question 4 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form.

61. Reflux Oesophagitis (without Hiatus Hernia) C QI Is there a secondary condition causing your reflux for example a hiatus hernia? This condition refers to Question 4 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

62. Retinal Detachment C QI This condition refers to Question 11 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form.

63. Rotator Cuff Have you had surgery? If so, when (month and year)? Do you have any current symptoms? C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

64. Back Pain What is the underlying cause of the back pain? Have you had any pain down your legs associated with back pain? Have you had any numbness or weakness in one of both legs or around your buttock? Are you still suffering with back pain? Is this constant? Does this affect you more at night? What treatment has been received to date? C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here. Do you have any treatment planned or anticipated?

65. Shoulder Sprain / Strain Have you had surgery? If so, when (month and year)? Do you have any current symptoms? C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

66. Rupture of knees C QI This condition refers to Question 8 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form.

67. Sebaceous Cyst Do you currently have a sebaceous cyst? If so, where is it located (include left / right / both)? If you have had a sebaceous cyst in the past, what treatment have you had and when (month and year)? C QI This condition refers to Question 6 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

68. Squameous cell carcinoma This condition refers to Question X of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

69. Stomach Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

70. Uterine Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

71. Unlisted Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

72. Basal Cell Carcinoma This condition refers to Question 5 of the Medical History. Have you been symptom and treatment free from your cancer for more than 5 years? C QI If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

73. Bladder Cancer C QI This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

74. Bone Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

75. Brain Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

76. Cold Sores (caused by the Herpes Simplex virus) C QI This condition refers to Question 6 of the Medical History. For Cold Sore only - Ask the 4 standard questions on the Additional Information page of the Application Form. If any other symptom of herpes simplex, please follow guide for Herpes Simplex.

77. Colorectal Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

78. Hepatitis A Are you currently undergoing treatment, or have any complications? C QI This condition refers to Question 4 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

79. Herpes Simplex Do you currently have herpes simplex, or do you have a history of it? Please provide details including how the condition affected you, what treatment you received, dates of treatment (month and year) and details of any ongoing treatment or investigation. C QI This condition refers to Question 6 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here. If only symptom of Herpes Simplex is Cold Sore, please follow guide for Cold Sore (Caused by Herpes Simplex virus).

80. Herpes Zoster / Shingles Is this condition present or do you have ongoing complications? How many episodes have you had? Have you fully recovered? C QI This condition refers to Question 6 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

81. Fungal Infections – external only Is this condition present or do you have ongoing complications? How many episodes have you had? Have you fully recovered? C QI This condition refers to Question 6 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

82. Urinary Tract Infection Is this condition present or do you have ongoing complications? How many episodes have you had? Have you fully recovered? C QI This condition refers to Question 9 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here.

83. Impaired Glucose Tolerance / pre Diabetes C QI This condition refers to Question 2 of the Medical History. Please ask the client’s Dr to complete Diabetes Medical Statement. – Click the Diabetes Symbol below for a copy:

84. Kidney Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

85. Leukaemia This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

86. Liver Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

87. Lung Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

88. Oesophageal Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

89. Ovarian Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

90. Pancreatic Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

91. Prostate Cancer This condition refers to Question 5 of the Medical History. C QI Have you been symptom and treatment free from your cancer for more than 5 years? If no, answer the 4 standard questions on the Additional Information page of the Application Form. If yes, please ask the clients treating Dr to complete the Cancer Medical Statement, available by clicking the icon.

92. Adenoiditis (Adenoidectomy) C QI This condition refers to Question 11 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here. When was the last time you had an attack of adenoiditis? (month and year) If you have had your adenoids removed, when did this happen (month and year)

93. Tonsillitis (tonsillectomy) C QI This condition refers to Question 11 of the Medical History. Ask the 4 standard questions on the Additional Information page of the Application Form. Now obtain the answers to the supplementary questions displayed here. When was the last time you had an attack of tonsillitis? (month and year) If you have had your tonsils removed, when did this happen (month and year)

94. Atrial Fibrillation (AF) Please ask the client’s Dr to complete Cardiac Arrhythmia Medical Statement. – Click the Cardiac Symbol below for a copy: C QI This condition refers to Question 1 of the Medical History.

95. Palpitations Please ask the client’s Dr to complete Cardiac Arrhythmia Medical Statement. – Click the Cardiac Symbol below for a copy: C QI Palpitations This condition refers to Question 1 of the Medical History.

96. Paroxysmal Atrial Fibrillation (Paroxysmal AF) Please ask the client’s Dr to complete Cardiac Arrhythmia Medical Statement. – Click the Cardiac Symbol below for a copy: C QI This condition refers to Question 1 of the Medical History.

97. Supra Ventricular Tachycardia (SVT) Please ask the client’s Dr to complete Cardiac Arrhythmia Medical Statement. – Click the Cardiac Symbol below for a copy: C QI This condition refers to Question 1 of the Medical History.