You and your health

Do you suffer from any of the following health conditions?

A musculoskeletal condition e.g. Osteoarthritis, patellofemoral pain syndrome

A heart condition e.g. Hypertensive heart, Coronary artery disease

Severe back, neck, joint pain

A digestive condition e.g Crohn's disease, IBS

An inflammatory arthritis condition e.g. Rheumatoid Arthritis, Lupus, Vasculitis, Polymyositis

High blood pressure

Autoimmune Disorder

Breathing conditions e.g. Asthma, Emphysema, Bronchitis

Diabetes

Osteoporosis, Osteomalacia, Paget's disease

Neurological diseases e.g. Epilepsy, Parkinson's, Huntington's

Blood-related illnesses e.g. Anaemia, Haemophilia, Hepatitis

A skin condition e.g Eczema, Psoriasis, Urticaria

Eye conditions e.g. Cataracts, Glaucoma, Tunnel Vision

Multiple Sclerosis

Myalgic Encephalopathy (ME)

A mental health condition e.g. Depression, Anxiety, Bipolar, Eating disorder

Deafness (to any degree)

Blindness (to any degree)

Disfigurement

Cancer

Developmental disorder e.g. Asperger's, Autism

Alzheimer's or Dementia

I have suffered from a stroke

Prefer not to say

None of the above

Are you registered as being disabled?

Yes

No

Prefer not to say

Which, if any, of the following common health conditions do you regularly suffer from?

Do you regularly or occasionally suffer from any of the following medical problems?

Cardiovascular problems

Chronic joint problems or Arthritis

Acid-related stomach problems such as heartburn, reflux or indigestion

Other problems with my digestion / stomach

Gastric or duodenal ulcers

Pathological hyper secretory conditions such as Zollinger-Ellison syndrome

None of these

Don’t know

Which, if any, of the following tobacco products do you use regularly?

You mentioned you use a Vape / Electronic cigarette, which of the following best describes your device?

What brand is your current device? If you own more than one device, please select all that apply.