Pernahkah anda menghidap atau diberitahu bahawa anda sedang menghidap atau telah menghidapi,atau menerima sebarang rawatan untuk yang berikut? Jika ya, sila lengkapkan borang di bawah: / Have you ever suffered from, or been told that you are suffering or have suffered from, or received any treatment for the following? If yes, please complete the form below :