I have had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance
I am over 45 years of age.
I struggle to perform moderate exercise (for example, walk 1.6 kilometer / one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months.
I have had problems with my eyes, ears, or nasal passages/sinuses.
I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.
I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurological injury or disease.
I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning or developmental disability.
I have had back problems, hernia, ulcers, or diabetes.
I have had stomach or intestine problems, including recent diarrhea.
I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefoquine / Lariam).