- I have had problems with my lungs/breathing, heart, blood, or have been diagnosed with COVID-19. YesNo
- Chest surgery, heart surgery, heart valve surgery, stent placement, or a pneumothorax (collapsed lung). YesNo
- Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise. YesNo
- A problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, OR am taking medication for any heart condition. YesNo
- Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema. YesNo
- I am over 45 years of age YesNo
- I struggle to perform moderate exercise (for example,walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12months YesNo
- I have had problems with my eyes, ears, or nasal passages/sinuses. YesNo
- I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery. YesNo
- I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease. YesNo
- I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning disability YesNo
- I have had back problems, hernia, ulcers, or diabetes. YesNo
- I have had stomach or intestine problems, including recent diarrhea YesNo
- I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine/Lariam). YesNo