2.1. Any eyesight problems/disease or condition which is not corrected by glasses or contact lenses e.g. glaucoma, colour blindness
2.2. Any injury or surgery to your eye(s) e.g. laser eye surgery
2.3. Any hearing problems e.g. ear infection, tinnitus or a hearing defect including deafness
2.4. Any problems with balance e.g. Vertigo, dizziness and giddiness
2.5. Epilepsy, fits, blackouts, fainting turns or unexplained loss of consciousness
2.6. A head injury leading to loss of consciousness requiring hospital admission
2.7. Recurrently suffer from headaches or migraines
2.8. Diseases of the nervous system e.g. stroke, multiple sclerosis
2.9. Chest pain, angina, heart disease or breathlessness
2.10.Had a chest x-ray in the last 5 years
2.11. Any circulation problems or varicose veins
2.13. Raised or low blood pressure
2.15. Any lung Disease e.g. Asthma, bronchitis, emphysema, pleurisy, pneumonia
2.16. Yourself or anyone in the family or household had TB
2.17. In contact with open TB at work
2.17b- if yes are you being followed up?
2.18. Recurrent nausea, dyspepsia, heartburn, indigestion or hiatus hernia
2.19. Any ulcers, gastric, duodenal or peptic
2.20. Inflammation of the bowel e.g. Crohn’s disease, ulcerative colitis, bleeding from rectum or diarrhoea lasting more than one week
2.21. Irritable bowel syndrome
2.22. Any liver problem e.g. Jaundice or any form of hepatitis
2.23. Any other abdominal complaint e.g. hernia
2.25. Recurrent kidney or urinary tract infection e.g. cystitis and urethritis
2.27. Any other kidney or bladder conditions
2.28. Any problems with bones or joints e.g. back, neck, knee, sciatica, any fracture or recurrent dislocation of a major joint
2.29. Have you ever consulted an orthopaedic surgeon, chiropractor, osteopath or physiotherapist?
2.30. Have you ever been diagnosed as having arthritis, gout, chondronmaicia patellae or rheumatism
2.31. Any skin disease e.g. Psoriasis, eczema, allergic skin rash
2.32. Any metabolic disorder e.g. diabetes, thyroid and adrenal gland disease
2.33. Any disorder of reproductive organs e.g. gynaecological, testicular and breast problems
2.34. Any infections diseases (apart from childhood illnesses) including sexually transmitted disease or tropical disease
2.35. Any eating disorder e.g. anorexia nervosa or bulimia
2.36. Substance misuse e.g. drugs, steroids
2.37. Any attempt at self-harm
2.38. Received or waiting for counselling, psychotherapy or psychiatric treatment
2.39. Any allergies e.g. hay fever, nut
2.40. Any operations or surgical procedures
2.41. Any malignancies or cancers
2.42. Any unexplained weight loss in the past year
2.43. In contact with MRSA in the last month
2.44. Tested positive for MRSA
2.45. Any family history of a congenital condition e.g. heart disease, strokes, nervous or mental illness
2.46. Any illness, infection, operation, serious injury or currently taking medication for anything not mentioned above