Medical History

    Particulars Driver Co-Driver
    Diabetes YesNo YesNo
    Family History YesNo
    If yes, then
    MotherFatherBoth
    YesNo
    If yes, then
    MotherFatherBoth
     
    Hyper Tension YesNo YesNo
    Family History YesNo
    If yes, then
    MotherFatherBoth
    YesNo
    If yes, then
    MotherFatherBoth
     
    Cardiac Disease YesNo YesNo
    Family History YesNo
    If yes, then
    MotherFatherBoth
    YesNo
    If yes, then
    MotherFatherBoth
     
    Asthma YesNo YesNo
    Family History YesNo
    If yes, then
    MotherFatherBoth
    YesNo
    If yes, then
    MotherFatherBoth
     
    Epilepsy YesNo YesNo
    Family History YesNo
    If yes, then
    MotherFatherBoth
    YesNo
    If yes, then
    MotherFatherBoth
     
    Any drug Allergies YesNo YesNo
    Please specify