Please complete the below information IN FULL to the best of your ability it will take approximately 10 minutes to complete. I understand and agree that all health information supplied by me in connection with the personal health assessment will be used by the staff to assess my health risk. I agree that the information can be used to suggest appropriate intervention programmes aimed at improving my health risk. I understand that participation in these programmes will be voluntary. I understand and agree that the information relevant to my current state of health can be disclosed to third parties for the purpose of analysis without disclosure of my identity. *

By agreeing and continuing with my booking below, I hereby understand that this HRA (Health risk assessment) is an added medical aid benefit available to me and hereby give Company wellness Solutions permission to claim this benefit directly from my medical aid. in the event of a failed claim due to insufficient HRA's available to me, I hereby understand that the funds will be deducted from my available savings and if no savings are available the claim will be resubmitted until such time the claim is successful. *