You will be asked a series of 35 questions having to do with your lifestyle, health, eating habits, exercise, how you handle stress, family history and medications and then you will be provided with a score so you can see how you are doing.

Let's Get Started!

Section 1. Lifestyle & Mental Health

(This section covers the biggest levers for health: behavior and mindset.)

1. How many times per week do you exercise? *

5+ times per week

3-4 times per week

1-2 times per week

Almost Never

exercise

2. Do you smoke? *

Yes

smoker

3. How would you describe your quality of sleep? *

my sleep is good (quality good & usually get 7 hours or more of sleep)

It varies (sometimes it's too little or interrupted 1-2 nights/week)

Not good (don't rest well and have trouble slleping or staying asleep 3 or more nights/week)

Very bad (have trouble sleeping/staying asleep most nights)

sleep quality

4. How many times per week to you practice prayer/meditation relaxation? *

5+ times per week

3-4 times per week

1-2 times per week

Almost Never

meditation

5. How many close friends do you have? *

5+ close friends

3-4 close friends

1-2 close friends

I don't have any close friends

friends

6. How do you describe the amount of stress you experience on average? *

Very little stress

Moderate amount of stress

An immense amount of stress

stress level

7. How well do you handle stress? *

Very Well

Not very well

Not good at all

stress management

8. Are you quick to get angry?

Yes

quick to anger

9. Are you often depressed or consider yourself a negative thinker? (the glass is half empty vs half full) *

Average

Yes

Depression

Section 2. Next, We will Explore Your Food & Eating Habits

(This is the most detailed section, focusing on nutrition quality.)

Click Next to continue

10. How many servings of fruit do you eat per day? (Example: a piece of fruit or a handful of berries.) *# Fruit

For this question, please count leafy greens, broccoli, squashes, etc. Do not count starchy vegetables such as corn or potatoes.

11. How many servings of vegetables do you eat per day? (A serving is what you would have with a meal) *

5+ servings of vegetable/day

3-4 servings/day

1-2 servings/day

Very little or None

12. Do you take dietary supplements? (Examples: Vitamins, Minerals, Omega-3, etc.) *

Yes

Supplements

13. When you eat bread... *

I rarely or don’t eat bread at all

I eat only sprouted breads or sour dough.

I mostly eat sliced sandwich style bread.

bread type

14. What type of oils do you cook with and consume? *

I avoid ALL seed oils & have eliminated them from my house.

I try and pay attention, but I use what is on hand.

What's a seed oil?

oils

When answering this question, consider servings of cereal, pasta, rice, crackers, potatoes, or bread as examples.

15. For carbohydrates during meals ... *

0-3 servings/week

4-6 servings/week

7+ servings/week

carb type

16. How many servings of white meat (poultry) do you eat per week? (A serving is what is typically consumed with a meal) *

2-3 servings/week

4 or more servings/week

1 serving/week

Little or None

poultry

A serving is typically what is consumed with a meal. Keep in mind that grass fed is best.

17. Red Protein Consumption? *

2 serving per week

1 serving per week

3 or more ( a little much )

Rarely or none

red meat

Fish is really good for us. More is not always better due to concerns of high levels of mercury. Wild Caught is always best.

18. Seafood Weekly Intake? *

1-2 servings/week

3-5 servings per week

Very little or none

fish

19. How many fast food or processed meals do you eat per week? (Examples: burgers, pizza, fried foods, packaged meals) *

Very little or none

1-2X per week

3-4X per week

Daily

fast food

20. Do you eat snacks? (Be honest!)

Almost never

Healthy snacks such as fruit or nuts, fresh veggie sticks

Cookies, chips, cake, snack bars, ice cream or candy

When answering this dairy question, think of a serving as a single container of yogurt, a glass of milk or a thick slice of cheese. Don't count alternatives like almond milk.

21. Daily dairy consumption (servings per day) *

Very little or None

1-2/day

3+/day

dairy

You may wonder why juice is included with soft drinks. That's a great question! Juice is always better than soft drinks, however, both can cause spikes in blood sugar, even diet sodas cause an insulin response which is sometimes worse.

22. Soft Drink/Juice consumption *

0 soft drinks and 0-2 juice servings/weeek

0 soft drinks, 3-4 juice servings/week

I love my soft drinks

Soft Drink/Juice

23. How many cups of coffee or tea do you drink per day? Please don't count decaffeinated coffee or tea *

0-1 cups/day

2 cups/day

3+/day

caffeine

24. How many servings of alcohol (e.g., beer, wine, strong liquor) do you drink per week? *

0-2 servings/week

3-4 servings/week

5+ servings/week

alcohol

Section 3. Let's explore Your family history and medical history.

To continue, hit Next

Consider family as parents, grandparents and great-grandparents.

25. Have you had family live to 85 years or older?

Yes

I don't know

26. How many close relatives have or had cardiovascular problems or diabetes? Include parents, grandparents, brothers or sisters. *

None

1 family memeber

2+ family members

I don't know

family health

27. How many close relatives have been diagnosed with cancer? Include parents, grandparents, brothers or sisters. *

None

1 family member

2+ family members

I don't know

cancer

Do you have a professional diagnosis for any of the following conditions: High Blood Pressure, High Cholesterol, Heart Disease, Anxiety/Depression, or Diabetes?

28. Do you have any of these diagnoses? *

I have NONE of these conditions

I have ONE of these conditions

I have TWO of these conditions

I have THREE or more of these conditions.

How many different types of medication (prescribed by a doctor) do you take? Include all prescriptions.

29. Please select from the following: *

None

1 prescription

2-3 prescriptions

4 or more

prescriptions

30. How many times a day do you clean your teeth? *

2 or more times of day

1 time

I often skip

oral health

31. Based on this definition what is your BMI? *

18.5-24 (considered normal)

25-30 (Slightly overweight)

< 18.5 (Underweight)

30 or more (overweight or obese)

BMI

Yay! Almost Done!

Only a few questions left.

Now for some demographic information.

Click Next to proceed!

32. What is your gender? *

gender

33. What is your age? *

age

34. What is your race/origin? *

origin

35. What is your marital status? *

marital status

Last Step!

Enter your name and email so we can email you your results!

First Name

Last Name

Email *

Phone