Eligibility

• Are you travelling contrary to medical advice or travelling to get medical treatment or medical advice abroad?

Yes No

• Are you awaiting investigative testing or treatment of an unresolved condition

Yes No

• Do you require kidney dialysis?

Yes No

• In the past 12 months, have you used or been prescribed home oxygen for a lung condition?

Yes No

• Do you have a terminal illness for which a physician has estimated you have less than 6 months to live?

Yes No

• Please confirm that every traveller can perform ALL the regular functions of daily living?

Yes No

Health Information

• Have you ever had, or are you awaiting a stem cell, bone marrow, or organ transplant (except corneal transplant)?

Yes No

• Do you have metastatic cancer

Yes No

• Have you had a medical check-up in the last 18 months?

Yes No

• Have you used a tobacco product of any nature in the last
  two years?

Yes No

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