Health Shield Declaration

I declare that I am not suffering from or been diagnosed with advised taken treatment or observation is suggested or undergone any investigation or consulted a doctor or undergone or advised surgery for any one or more from the following:

  • High Blood Pressure, Heart Attack or any other Heart Disease, abnormal lipid levels;
  • Stroke, Paralysis in any form, or any other Cerebrovascular Disease;
  • Diabetes or thyroid/parathyroid or any other Endocrinal Disease, Any Kidney Disease;
  • Acute / Chronic Liver (Failure/ Disease), Cirrhosis of Liver, Alcoholic liver disease; any pancreatic disease
  • Any Lung Disease (e.g. Chronic Obstructive Pulmonary Diseases, Parenchymal lung Disease, Pulmonary Embolism etc.).
  • Blood Disorders, Gastro-Intestinal Diseases, Ulcer or any other disorder of the bones, spine or muscle;
  • Any Cancer or Cancerous growth;
  • Any Mental or Psychiatric condition, any Genetic Disease, autoimmune or any disease related to central nervous system [disease related to brain]; Congenital conditions;
  • HIV / AIDS or AIDS related complications,
  • Covid positive in last 3 months
  • Any h/o sudden loss of weight in last 1 yr
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