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MEDICAL QUESTIONNAIRE FORM

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MEDICAL QUESTIONNAIRE FORM

Basic Info

  • Applicable Region UAE
  • Available Languages
    English & Arabic
  • Document No 0000245
  • Version V 1.0
  • Last Updated 07-06-2023
  • Reviews 0
Document Summary

This “Medical Questionnaire Form (Long)” is prepared and issued by a company mainly to collect information for the employer/insured to determine ability to perform job duties and/or to analyse or evaluate employee’s compensation claims submitted in the future.

Description

This “Medical Questionnaire Form (Long)” should be signed by the applicant/employee.  

Jurisdiction

This form is intended for use in the UAE.

Before Execution

- The information on this front page or contained in the headers and footers of this instrument are for guidance purposes only.

- Please delete this front page together with the information contained in the headers, footers and the endnotes prior to circulating this form. Where square brackets […] and highlights are used in the document, it indicates that there is missing or incomplete information which will need to be incorporated prior to signature.

- Please remove the square brackets and all highlighting prior to signature.