MusculoSkeletal Questionnaire Application Supplement - FL, 17985fl 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information in the 'Proposed Insured' section, including your birth date.
  3. In the first question, provide details about any musculoskeletal issues you've experienced in the last 10 years. Include diagnoses and treatment received.
  4. If applicable, indicate whether you have had surgery for these conditions and fill in the required details such as type of surgery and hospital information.
  5. Answer whether you have used any medications related to your conditions, providing names, dosages, and relevant dates.
  6. Respond to the question regarding missed workdays due to these conditions, detailing dates if necessary.
  7. Use the remarks section for any additional information that may be pertinent to your application.
  8. Finally, review all entries for accuracy before signing and dating the form at the bottom.

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