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Which best describes your use of tobacco, vaping or nicotine replacement products?

Never used / none in the last 5 yearsNone in the last 12 monthsUsed in the last 12 months

If you have used tobacco or nicotine products in the last 12 months, which do you currently use and how much?

CigarettesSmall cigars / cigarillosCigarsPipeVape / e-cigaretteNicotine replacementOther

Before age 65, have any of your natural parents, brothers or sisters been diagnosed with, or died from, any of the following? Select anything that applies.

Heart attack, angina or strokeBreast or ovarian cancerBowel / colon cancer or polypsDiabetesMultiple sclerosisParkinson's diseaseAlzheimer's disease / dementiaMotor neurone diseaseMuscular / myotonic dystrophyHuntington's diseaseCardiomyopathyPolycystic kidney diseaseAnother cancerAnother inherited / familial conditionNone / Don't know

Have you ever had, or in the last 5 years received treatment, counselling, medication or specialist help for, a mental health condition? Select anything that applies.

DepressionAnxietyStressInsomniaEating disorderBipolar disorder / manic depressionSchizophrenia / psychosisPersonality disorderAnother mental health conditionNone

Have you ever had thoughts of suicide, attempted suicide, intentionally harmed yourself, or had thoughts of harming yourself?

YesNo

Have you ever had any of the following? Select anything that applies.

Cancer, lymphoma or leukaemiaHeart attack, angina, heart disease, valve / structural heart problem or cardiomyopathyStroke, TIA, brain haemorrhage, brain injury or brain surgeryDiabetes, pre-diabetes or raised blood sugarHIV, hepatitis B or hepatitis CEpilepsy or seizuresMultiple sclerosis or another neurological conditionMuscular dystrophy or cerebral palsyParkinson's diseaseAlzheimer's disease / dementiaNone

In the last 5 years, have you had or received treatment for any of the following? Select anything that applies.

Raised blood pressureRaised cholesterolChest pain or irregular heartbeatKidney, bladder, liver or pancreas conditionAnaemia, haemophilia or another blood disorderPersistent numbness, tingling, tremor, loss of balance or weaknessCrohn's disease, colitis, IBS or another digestive conditionAsthma, sleep apnoea or another lung / breathing conditionGrowth, lump, cyst or polypAbnormal cervical smear / HPV result, mammogram or gynaecological conditionBack, neck or shoulder problemJoint pain, arthritis or other limb / musculoskeletal problemTinnitus or another ear / hearing / balance problemEye or vision problem other than routine sight correctionChronic fatigue / recurrent fatigueFibromyalgiaNone

Apart from anything already mentioned, in the last 3 years have you had any of the following?

Medication or treatment lasting more than 1 monthCounsellingReferral to a specialist or medical professionalBlood tests, scans or other investigationsFollow-up appointments or monitoringMore than 2 weeks off work because of illness or injuryNone

Are you currently waiting for tests, investigations, treatment, specialist review or follow-up?

YesNo

In the last 3 months have you had any new or unexplained symptoms such as a new lump, swelling, changed mole, unusual bleeding, unexplained weight loss, persistent fatigue, a cough lasting more than 3 weeks, a fit / seizure, or another symptom you plan to discuss with a medical professional?

YesNo

Have you ever been treated in hospital for COVID-19 or been told you have Long COVID?

YesNo

Have you ever received advice, treatment or counselling because of alcohol use, been advised to reduce your alcohol intake for a medical reason, or had tests because of alcohol use?

YesNo

In the last 10 years have you used recreational drugs, non-prescribed stimulants / sedatives / tranquillisers, anabolic steroids, or methadone?

YesNo

Are you currently a UK resident?

YesNo

In the last 2 years have you seen, or do you intend to see, a doctor outside the UK for treatment, investigations or medical advice?

YesNo

Have you lived in Africa, Thailand, Russia, Ukraine or the Caribbean for more than 3 months during the last 2 years?

YesNo

In the next 2 years do you intend to travel, live or work outside the EU, Isle of Man, Channel Islands, Australia or New Zealand, excluding ordinary holidays of less than 30 days in a year?

YesNo

Do you currently, or do you intend to, take part in any higher-risk sport or pastime? Select anything that applies.

MountaineeringScuba / deep sea divingSailing other than inlandFlying other than as a fare-paying passengerMotor sportExtreme sportMartial arts / combat sportProfessional or semi-professional sportNone