Face-it Scan • The Unisure Group

Given Name

Family Name

Date of Birth

Gender at Birth

Height
Please enter your height in centimeters

Weight
Please enter your weight in kilograms

Home Country

Residence Country

Email Address

Smoking Status

No, never smoked No, smoked more than five years ago No, smoked within the last five years Yes, currently a smoker

Activity Level

Sedentary Lightly active Moderately active Fairly active Highly active

Do you use chronic medication?

No Yes, medication for 1-2 conditions Yes, medication for 3 or more conditions

Do you use blood pressure medication?

No Yes

I consent to receive marketing communications from Unisure via email. These communications may include information about products, services, promotions, and events. I understand that I can withdraw my consent at any time by contacting Unisure at info@unisuregroup.com.

I consent to the collection and processing of my personal data by Unisure for the purposes of the Face-iT Scan^®. I understand that my data may be shared with trusted third-party service providers. I have the right to access, rectify, or erase my personal data as per Unisure's Data Protection Policy.

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