Health and Lifestyle Assessment
Do you have high blood pressure..?
Yes
No
▼
Do you have high cholesterol:
Yes
No
▼
Do you have coronary heart disease (CHD) or myocardial infarction:
Yes
No
▼
Do you smoke?
Yes
No
▼
Have difficulty walking or climbing stairs:
Yes
No
▼
Consume fruit 1 or more times per day:
Yes
No
▼
Consume vegetables 1 or more times per day:
Yes
No
▼
Are you a heavy drinker?
Yes
No
▼
Have you done any cholesterol test in the last 5 years?
Yes
No
▼
Have you ever had a stroke before?
Yes
No
▼
What's your Body Mass Index (BMI)?
What's your age?
18-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
▼
What's your education level?
Never Attended School
Elementary
High School
Some College Degree
Advanced Degree
6
▼
What's your income level?
less than $10,000
less than $15,000
less than $20,000
less than $25,000
less than $35,000
less than $50,000
less than $65,000
less than $75,000
▼
From a scale of 1 to 5, how would you rate your general health?
excellent
very good
good
fair
poor
▼
now thinking about the past 30 days, lets answer some questions...
How many days have you done any physical activities in the past 30 days?
0
days
How many days have you had any mental health issues in the past 30 days?
0
days
How many days have you had any physical health illness or injuries in the past 30 days?
0
days
Submit Data