Do you suffer from any of these health conditions?

Mental Disorder, Major depression, bipolar or schizophrenia, Cancer, ALS, Alzheimers, HIV/AIDS, Stroke/TIA, Hepatitis, any Chronic illnesses

Yes

No

Are you in hospice, and/or confined to a hospital or nursing facility?

Yes

No

Do you take prescription medications for high blood pressure, diabetes, or anxiety?

Yes

No

Which of these best describe you?

Non-smoker

Smoker

I don't drink much

I like to drink

Walk/exercise 3x/week

No regular exercise

Your real weight, don’t worry we won’t tell anyone.

Height

0'0"

4'7'

Weight

0lbs

75lbs400+