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...Small group business medical questionnaire instructions this form to be completed by employer please note groups with no prior fully insured coverage a newly formed or lapse in of greater than days must complete the individual health any requesting basic life benefits guarantee issue level information name address include city state zip code telephone number federal tax id best your knowledge answer following questions for all enrolling employees proprietors partners corporate officers continuation covered under present plan on is designed assist aetna s evaluation past three years has person consulted care provider received treatment including prescription medications been hospitalized conditions disorders diseases yes heart and circulatory attack surgery chest pain murmur stroke high blood pressure cholesterol brain nervous system seizures paralysis multiple sclerosis migraine headaches depression anxiety cancer tumors tumor radiation chemotherapy endocrine diabetes lupus chronic fat...