1. Have you had any of the following in the last 12 months?

2. Have you had any of these conditions in the last 12 months?

Choose a condition if, in the specified timeframe, you had the condition, whether or not you received any medical care for it. This includes conditions controlled or managed by medication, a medical device, diet or excercise.

3. In the last 12 months, have you smoked any tobacco products, or vaped any nicotine products (including e-cigarettes)?