The information contained in this questionnaire was compiled in compliance with the Workforce Healthcare GP standards and is approved for general public use.
ASI Financial Services is an authorised financial services provider (“ASI”), FSP Number: 43952. All referrals, opinions, conclusions, advice and other information received by the Applicant as a result of completing this questionnaire are from third parties not associated with ASI and does not constitute medical advice or advice in terms of the Financial Advisory and Intermediary Services Act of 2002 and further shall be understood as neither given nor endorsed as such by ASI. Use of the information provided is entirely at the Applicant’s discretion and risk. ASI is not liable for any general, special, incidental, or consequential damages of any nature whatsoever arising from the completion of the questionnaire or any referrals, opinions, conclusions, advice and other information resulting therefrom received by the Applicant. By completing this questionnaire, the Applicant hereby consents to ASI, as well as any third party medical advisory company applicable, obtaining, recording, and utilising any personal information of whatsoever nature provided by the Applicant to ASI for any reason whatsoever. Should the Applicant provide ASI with the personal information of a third party for any reason whatsoever, he/she warrants that he/she has obtained the necessary consent, from the applicable third party, to provide such information to ASI.