Longevity Questionnaire – With Responses"*" indicates required fieldsStep 1 of 714%Name* First Last Email* This is required in order to receive your report and suggestions.Sex* Female MaleAge*Country*Health Care (Pillar 1 of 6)Do you smoke?* Yes Quitted more than a year ago Quitted more than 10 years ago Quitted smoking more han 15 years ago No, neverHow many servings of alcohol on average do you drink per week? 1 serving is a glass of wine or a can of beer* 0 to 2 2 to 5 More than 5How often do you arrange check-ups with blood work with your healthcare provider?* Every 6 months Annually Every 2 years At longer intervalsAre you proactive in seeing a doctor when you feel something is wrong?* Yes NoDo you use any type of wearables to help with tracking your health?* Yes NoHow regularly do you engage in thermal activities like using a sauna, cold plunge, or taking cold showers?* Never Once a month Once a week More than once a weekHealth Care ScoreExercise (Pillar 2 of 6)How much total time per week do you spend on activities that raise your heart rate?* None Less than 1 hour 1 to 2.5 hours 2.5 hours to 5 hours More than 5 hoursHow much time you spent doing strength training, like lifting weights or resistance bands?* None 10 -30 minutes 30 – 60 minutes 1 – 2 hours More than 2 hoursHow much time you spent doing exercises to improve balance, like yoga, tai chi, pilates?* None 15 – 60 minutes 1 – 2 hours More than 2 hoursDo you include stretching exercises before or after your workout?* No YesExercise ScoreNutrition (Pillar 3 of 6)What is you height in cm?*What is your weight in kg?*Your BMI isHow many times per week do you consume pre-packaged or fast food meals?* Never Once a week or less 2-3 times per week 4-5 times per week More than 5 times per weekHow much water do you drink daily?* Less than 1L (35oz) 1-2L (35oz – 70oz) More than 2L (70oz)Are you currently using any health or longevity supplements?* No YesHow many total hours per day are you fasting, including sleep time?* Less than 8 hours 8 – 11 hours 11 – 12 hours More than 13 hoursNutrition ScoreSleep (Pillar 4 of 6)How would you rate your sleep quality overall?* Very good Fairly good Fairly poor Very poorHow many hours of sleep do you usually get every night?* Below 6 hours 6 – 7 hours 7 – 8 hours 8 – 9 hours More than 9 hoursHow many times do you wake up at night on average?* 0 – 2 times 2 – 3 times More than 3 timesHow many days during the week do you go to bed and wake up at the same time?* Less than 3 days 3 – 5 days 5 – 7 daysHow many times a week do you use sleep medication?* 4 or more days 2 – 3 days 1 day NeverDo you have a relaxing bedtime routine?* Yes NoDo you feel that your bed, noise level and temperature provide an optimal sleep environment?* Yes NoSleep ScoreMental Health (Pillar 5 of 6)During last 2 weeks how often did you feel down, depressed, or hopeless?* Never 1 – 6 days More than 7 daysHow often a week do you meditate or practice mindfulness?* Never 1 – 2 times per week 3 – 5 times per week Every dayHow many hours per week do you spend on hobbies or activities that bring you joy?* Less than 1 hour 1 – 3 hours More than 3 hoursHow often a week do you meet with family or friends?* Never 1 – 2 times 3 – 4 times More than 5 timesHow regularly do you engage in conversations where you openly share your feelings with someone you trust?* I don’t, I keep my feeling to myself. Rarely. Only in exceptional circumstances Sometimes. When prompted or during significant life events Frequently. It’s a regular part of my interactionsHow active are you in community groups?* Not involved I occasionally participate I regularly attend or contribute I am a key member or organizerHow often do you engage in brain-stimulating activities, such as puzzles, chess, or learning new language?* Rarely or never Monthly Weekly Several times per weekMental Health ScoreMindset (Pillar 6 of 6)How much do you feel age restricts you from achieving personal goals and leading a fulfilling life?* I feel age somewhat restricts me. Age has minimal impact on my goal achievement or life fulfillment. I don’t see age as a barrier to my personal goals or happinessUntil what age do you foresee maintaining an active lifestyle?*Do you consider yourself a positive person?* Yes, I am generally optimistic. Neutral, I have a balanced outlook. No, I tend to be more pessimistic.Do you set goals and prioritize activities that promote your overall well-being and longevity?* Yes, regularly and consistently Sometimes, but not consistently Rarely or neverHow easily do you find purpose and meaning in your everyday life?* With difficulty Somewhat easily Quite easilyAre you part of a community that encourages a focus on long-term health and well-being?* Yes NoMindset ScorePhoneThis field is for validation purposes and should be left unchanged. Share what you've learned!
