Get Q36 Aviva

The Q36 Aviva online form is a crucial document for individuals applying for health insurance coverage. This guide provides a comprehensive overview of how to accurately fill out each section of the form to ensure a smooth application process.

Follow the steps to fill out the Q36 Aviva online form effectively.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. In the 'Particulars of Life Assured' section, provide your full name, identification document number (either your Identity Card or Passport), and the contract number for reference.
3. Proceed to the 'Medical Questions' section. Begin by stating the diagnosis made by your healthcare provider.
4. Indicate when the condition was diagnosed by entering the date. Next, confirm whether you have made a full recovery without ongoing symptoms or required treatment by checking either 'Yes' or 'No'.
5. If you answered 'Yes', specify how long it has been since your full recovery. If 'No', describe how often you experience symptoms and detail the nature of the symptoms.
6. Provide information regarding the treatment prescribed by your doctor. Select the appropriate options regarding medication (Oral Medication or Others), supplying details like medication name, dosage, frequency, and relevant dates.
7. Indicate how frequently your condition is monitored or checked by a healthcare provider.
8. State whether you have undergone any investigations or tests related to this condition, checking 'Yes' or 'No'. If 'Yes', provide specific details, types of investigations or tests, dates, and results.
9. Detail any planned investigations, tests, treatments, or surgeries by checking 'Yes' or 'No' and providing respective details.
10. Address any complications that might arise due to the condition by indicating 'Yes' or 'No', and if 'Yes', provide descriptive details.
11. If you have ever been hospitalized or had outpatient follow-up for the condition, share the hospital's name, admission date, duration of stay, and date of last follow-up.
12. Indicate if you have taken time off work or school as a result of this condition by checking 'Yes' or 'No' and include relevant dates and duration.
13. Provide the name and address of the doctor, clinic, or hospital that was consulted for this condition, along with the date of the last consultation.
14. Read the Declaration carefully. Ensure you agree to notify Aviva about any changes in health status and acknowledge that the information provided is true and complete.
15. Finally, sign and date the form, ensuring the signatures are dated correctly to validate your submission. Save your changes, and you may then download, print, or share the completed form as needed.

Complete your Q36 Aviva form online for a seamless insurance application experience.