Blood type Gender

Height Weight

What illnesses (other than colds/flu) have you had in the past three years?

Do you have any physical disabilities for which you will need special arrangements while abroad?

Do you have any chronic illnesses or allergies ?

What prescription drugs do you regularly use?

Are you on a restricted diet by choice or medical necessity?

Have you or are you receiving treatment for any mental health problems?

Have you or are you receiving treatment for an eating disorder?