Check Yo Self

We want to help you.
1. How old are you?
under 18
18-19
20-29
30-39
40-49
50-593
over 50

2. In general, how would you rate your overall health?
Excellent
Very Good
Good
Fair
Poor

3. What is your height in feet and inches?


4. What is your current weight in pounds?


5.Do you smoke cigarettes?
Yes
No

6. About how many alcoholic drinks do you consume in a week?
0
1-4
5-8
9-12
13-16
More than 16

7. How many hours do you sleep each night?


8. What type of lifestyle best reflects yours?
Sedentary-irregular physical activity
Moderate-some excerise, less than 2.5 hours per week
Active-working out vigorously for at least 2.5 hours a week

9. How often do you eat fast food?
Always
Usually
Sometimes
Rarely
Never

10. When is the last time you visited the doctor?
Less than 6 months ago
6 months to a year ago
1 year to 2 years ago
2 years to 3 years ago
3 or more years ago