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Medical Questionnaire

Insurers ask a range of questions to assess how they will treat your application. In order to help us place your insurance application with the correct insurer and to make sure the application goes as smoothly as possible, please answer the following questions to the best of your ability. Whilst some may seem somewhat invasive, each question will help with the process. 
Do you smoke or have you in the last 12 months?

(This includes Nicotine replacements, Tobacco Products & Electronic Cigarettes)

(A pint of low strength beer or a standard size glass of wine is typically around 2 units)

In the last 5 years have you taken any recreational drugs such as Cannabis, Cocaine, Ecstasy, Heroin etc?
Have you ever had any of the following?
In the last 5 years have you had any of the following?
Apart from anything you may have already told us about, within the last TWO years have you:
Apart from anything you've already told us about:
Have any of your natural parents, brothers or sisters been diagnosed with, or died from, any of the following before age 60?
Do you take part in any of the following?
Do you currently ride a motorbike?
Have you ever been banned from driving?
During the last three years, have you spent more than 90 days in total in Africa, the Caribbean, Russia, Thailand or Ukraine?
Are you currently living outside of, or during the next 12 months do you intend to spend more than 30 days outside of:
Within the last 30 days have you:
Do you want to add any of the below specific covers to your Protection policies?
I consent for the relevant insurer to contact my GP surgery to request medical information pertinent to my application

Thanks for submitting!

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