zh-hant+1 604 278 1668 info@ehometravel.com

Travel Insurance Questionnaire

The following questions will require a YES or NO response. 以下問題需要以「是」或「否」回答:

Please enable JavaScript in your browser to complete this form.
Name
Question 問題 1
In the past 6 months have you been prescribed, refilled or taken prescription medication, other than birth control, low-dose aspirin, or antibiotics? 在過去6個月中,您是否被開立、補充或服用處方藥物,除了避孕藥、低劑量阿斯匹林或抗生素以外?
Question 問題 2
Have you been diagnosed with or had any cancer treatment in the past 6 months? (This does not include basal or squamous cell skin cancer or breast cancer treated only with hormone therapy.) 在過去6個月中,您是否被診斷出患有癌症或接受了任何癌症治療?(不包括基底細胞癌、鱗狀細胞皮膚癌或僅接受激素療法治療的乳腺癌。)
Question 問題 3
Have you used any tobacco or nicotine products in the past 6 months? 在過去6個月中,您是否使用過任何煙草或尼古丁產品?
Clear Signature