Q1. Within the past 12 months, and in relation only to the medical conditions listed below, have you:

• been newly diagnosed with? 
• been prescribed any new medication or any change in medication for?
• had any new or change in treatment, including investigation or testing (do not count regular scheduled maintenance investigations or testing)? 
• been referred to a specialist for? 
• been hospitalized or seen in the emergency department of a hospital?

Any of the following medical conditions:

1. a heart condition
2. a lung condition
3. shortness of breath
4. chest pain
5. stroke, or mini-stroke or TIA (Transient Ischemic Attack)?

Q3. Within the past 12 months have you:

1. been treated for and/or been diagnosed with internal bleeding; or
2. been admitted to hospital for a gastrointestinal disease or disorder; or
3. received treatment including investigation or testing where the results indicate either a new diagnosis of cancer or that cancer has returned or spread (except basal cell and squamous cell skin cancer or breast cancer treated only with hormonal therapy)?

Q4. Within the past 12 months have you been prescribed or taken any of the following:

1. prednisone for any lung condition; or
2. any form of nitroglycerin for the relief of angina pain (including on an "as needed" basis)?

Q5. Within the past 12 months have you been prescribed or taken medications for both diabetes and a heart condition?

(Answer No if you are medicated for one but not both of these conditions. Medication prescribed solely for the control of blood pressure is not a medication for a heart condition.

Q1. Within the past 12 months, and in relation only to the medical conditions listed below, have you:

• been newly diagnosed with? 
• been prescribed any new medication or any change in medication for?
• had any new or change in treatment, including investigation or testing (do not count regular scheduled maintenance investigations or testing)? 
• been referred to a specialist for? 
• been hospitalized or seen in the emergency department of a hospital?

Any of the following medical conditions:

1. a heart condition
2. a lung condition
3. shortness of breath
4. chest pain
5. stroke, or mini-stroke or TIA (Transient Ischemic Attack)?

Q3. Within the past 12 months have you:

1. been treated for and/or been diagnosed with internal bleeding; or
2. been admitted to hospital for a gastrointestinal disease or disorder; or
3. received treatment including investigation or testing where the results indicate either a new diagnosis of cancer or that cancer has returned or spread (except basal cell and squamous cell skin cancer or breast cancer treated only with hormonal therapy)?

Q4. Within the past 12 months have you been prescribed or taken any of the following:

1. prednisone for any lung condition; or
2. any form of nitroglycerin for the relief of angina pain (including on an "as needed" basis)?

Q5. Within the past 12 months have you been prescribed or taken medications for both diabetes and a heart condition?

(Answer No if you are medicated for one but not both of these conditions. Medication prescribed solely for the control of blood pressure is not a medication for a heart condition.

Q1. Within the past 12 months, and in relation only to the medical conditions listed below, have you:

• been newly diagnosed with? 
• been prescribed any new medication or any change in medication for?
• had any new or change in treatment, including investigation or testing (do not count regular scheduled maintenance investigations or testing)? 
• been referred to a specialist for? 
• been hospitalized or seen in the emergency department of a hospital?

Any of the following medical conditions:

1. a heart condition
2. a lung condition
3. shortness of breath
4. chest pain
5. stroke, or mini-stroke or TIA (Transient Ischemic Attack)?

Q3. Within the past 12 months have you:

1. been treated for and/or been diagnosed with internal bleeding; or
2. been admitted to hospital for a gastrointestinal disease or disorder; or
3. received treatment including investigation or testing where the results indicate either a new diagnosis of cancer or that cancer has returned or spread (except basal cell and squamous cell skin cancer or breast cancer treated only with hormonal therapy)?

Q4. Within the past 12 months have you been prescribed or taken any of the following:

1. prednisone for any lung condition; or
2. any form of nitroglycerin for the relief of angina pain (including on an "as needed" basis)?

Q5. Within the past 12 months have you been prescribed or taken medications for both diabetes and a heart condition?

(Answer No if you are medicated for one but not both of these conditions. Medication prescribed solely for the control of blood pressure is not a medication for a heart condition.

Q1. Within the past 12 months, and in relation only to the medical conditions listed below, have you:

• been newly diagnosed with? 
• been prescribed any new medication or any change in medication for?
• had any new or change in treatment, including investigation or testing (do not count regular scheduled maintenance investigations or testing)? 
• been referred to a specialist for? 
• been hospitalized or seen in the emergency department of a hospital?

Any of the following medical conditions:

1. a heart condition
2. a lung condition
3. shortness of breath
4. chest pain
5. stroke, or mini-stroke or TIA (Transient Ischemic Attack)?

Q3. Within the past 12 months have you:

1. been treated for and/or been diagnosed with internal bleeding; or
2. been admitted to hospital for a gastrointestinal disease or disorder; or
3. received treatment including investigation or testing where the results indicate either a new diagnosis of cancer or that cancer has returned or spread (except basal cell and squamous cell skin cancer or breast cancer treated only with hormonal therapy)?

Q4. Within the past 12 months have you been prescribed or taken any of the following:

1. prednisone for any lung condition; or
2. any form of nitroglycerin for the relief of angina pain (including on an "as needed" basis)?

Q5. Within the past 12 months have you been prescribed or taken medications for both diabetes and a heart condition?

(Answer No if you are medicated for one but not both of these conditions. Medication prescribed solely for the control of blood pressure is not a medication for a heart condition.

Q1. Within the past 12 months, and in relation only to the medical conditions listed below, have you:

• been newly diagnosed with? 
• been prescribed any new medication or any change in medication for?
• had any new or change in treatment, including investigation or testing (do not count regular scheduled maintenance investigations or testing)? 
• been referred to a specialist for? 
• been hospitalized or seen in the emergency department of a hospital?

Any of the following medical conditions:

1. a heart condition
2. a lung condition
3. shortness of breath
4. chest pain
5. stroke, or mini-stroke or TIA (Transient Ischemic Attack)

Q3. Within the past 12 months have you:

1. been treated for and/or been diagnosed with internal bleeding; or
2. been admitted to hospital for a gastrointestinal disease or disorder; or
3. received treatment including investigation or testing where the results indicate either a new diagnosis of cancer or that cancer has returned or spread (except basal cell and squamous cell skin cancer or breast cancer treated only with hormonal therapy)?

Q4. Within the past 12 months have you been prescribed or taken any of the following:

1. prednisone for any lung condition; or
2. any form of nitroglycerin for the relief of angina pain (including on an "as needed" basis)?

Q5. Within the past 12 months have you been prescribed or taken medications for both diabetes and a heart condition?

(Answer No if you are medicated for one but not both of these conditions. Medication prescribed solely for the control of blood pressure is not a medication for a heart condition.