Medical History Questionnaire

Solidarity Members primarily share into new illnesses or injuries and preventative care; however some Pre-Exisiting Conditions may also be eligible for sharing. Pre-Existing Conditions are evaluated and placed into categories outlined in the Sharing Guidelines

If you are not sure if your pre-existing conditions are eligible for sharing, you may use the Medical History Questionnaire form to submit your medical history for review. Please note that the form only allows one Member per submission. 

Once your information is received, we will review your medical history and reach out when the review is complete. 

Fill out the Medical History Questionnaire 

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