Are you in good health? *

yes   no  

Do you suffer from any pre-existing medical conditions? *

yes   no  

Please explain: *

Do you Smoke? *

yes   no  

Rank yourself: *
occasional   moderate   heavy  

Have you ever suffered a nervous breakdown, depression or other emotional disorders? *

yes   no  

Have you ever had a Drug addiction/problem? *

yes   no  

Do you have any visible Tattoos when wearing shorts or a T-Shirt? *

yes   no