Medical Form

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Medical Form
Medical consent:
Do you suffer from any of the following:
YesNo
Allergies (including medication, plasters, stings, pollen etc)
Do you have any dietary requirements (including allergies)
Asthma or breathing difficulties
Diabetes
Sensory Loss (sight, speech or hearing)
Travel Sickness (any medication needed)
Have you received any medical or surgical treatment in the last 3 months?
Have you...
YesNo
been vaccinated against Tetanus in the last 10 years?
Where The Fruit Is - Social Enterprise Registered as a limited company In England and Wales
Company Number 10832411
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