Health plan questionnaire
Select language: Malay | Chinese
Age years old
Gender Male Female
Are you a smoker? Yes No
Do you have any of the following risk factors for heart disease (coronary artery disease)? Yes No
  • Family history of premature coronary artery disease
  • Hypertension
  • Elevated LDL (more than 4.1 mmol/l or 160 mg/dl)
  • Reduced HDL (less than 1.0 mmol/l or 39 mg/dl)
  • Diabetes mellitus
Do you have any symptoms of heart burn, epigastric pain, bloatedness or family history of stomach cancer? Yes No
Do you have any family history of polyps or colon cancer? Yes No