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Health Survey

Have you ever experienced:
Heart disease
Cancer
High blood pressure
High cholestorol
Sleep apnea or snoring
Severe case of COVID-19
Bladder disease
Erectile dysfunction
Arthritis
Stroke
Depression
Anxiety
Alcohol abuse
Drug abuse
Pancreatitis
Liver disease
Lung disease
Gallstones
Gout
Infertitlity
Migraines
Hypertension
Joint pain
Back pain
What is your gender?
Male
Female
Other
How old are you?
17 or under
18-20
21-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61-65
66-70
71-75
76-80
81-85
86-90
91-95
96 or over
Are you a smoker?
Yes
No
How tall are you?
4'9" or under (146 cm)
4'10"-5' (147-154 cm)
5'1"-5'3" (155-161 cm)
5'4"-5'6" (162-169 cm)
5'7"-5'9" (170-177 cm)
5'10"-6" (178-182 cm)
6'1"-6'3" (183-190 cm)
6'3"-6'5" (191-195 cm)
6'5"-6'7" (196-203 cm)
6'8" or over (203 cm)
How much do you weigh?
50 lbs or less (23 kg)
51-100 lbs (23-45 kg)
101-150 lbs (46-68 kg)
151-200 lbs (69-90 kg)
201-250 lbs (91-113 kg)
251-300 lbs (114-136 kg)
301 lbs or over (137+ kg)
What is your waist size?
21" or less (57 cm)
23-24" (57-61 cm)
24-26" (61-65 cm)
26-27" (65-69 cm)
28-30" (73-77 cm)
31-33" (81-85 cm)
35-37" (89-93 cm)
38-40" (97-101 cm)
40-42" (101-106 cm)
42-44" (108-112 cm)
45-47" (116-120 cm)
48-50" (122-127 cm)
51" or more (129 cm)
Email (optional):
All done! Do you like interesting blog posts?
Yes
No
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