Translation medical aspect

2. Illnesses, ailments, addictions

2.1 Do you suffer from one or not healed without consequences:

• Disease of the respiratory organs

• Disease of the heart or blood vessels

• kidney disease

• nerve disease

• Disease of the abdominal organs

• accident Injury

2.2 Suffering or ever suffered from:

• fainting fit’s

• debility

• Addictions ( alcohol, narcotics, medicines )

• mental illness

• Epilepsy or epilepsy seizures similar

• deafness

2.3 to your knowledge, your blood pressure is normal:

if no:       to high           to low

2.4 have you ever been hospitalized in a sanatorium for alcoholics

2.5 have you ever gone through a detoxification for drug

2.6 have you ever  hospitalized in a clinic for the mentally ill or soul ill

2.7 Do you have any other illnesses or disability, you could limit the safe driving of a motor vehicle

2.8 additions: ________________________________________

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