1)
Where do You Live?
China
India
United States of America
Indonesia
Brazil
Pakistan
Nigeria
Bangladesh
Russia
2)
What is Your Gender?
Male
Female
3)
Do You Smoke?
Often
Occasionally
Quit at 40
Quit at 50
Quit at 60
Never Smoked/Quit below 35
4)
5)
Approximately How Old was Your Last Grandparent that Died of NATURAL CAUSES?
Grandparents are still alive, but are under 70
20
30
40
50
60
70/Still alive, but are 70-80
80+/Still alive, but are over 80
6)
How Often do You Exercise?
Conditionally
Almost daily
Daily
Moderately
Lightly
Sedentarily
Never
7)
How is the Condition of Your Weight?
Severely Underweight
Very Underweight
Underweight
Normal weight
Overweight
Obese
Severely Obese
8)
What Income Level Are You?
Lower income (< $50K/year)
Middle income (between $50K and $200K/year)
Upper income (between $200K and $500K/year)
Rich (> $500K/year)
9)
What is Your Education Level?
Lower (Grade School or no College)
Middle (Some College)
Upper (University or Ph. D)
Still in School
10)
Do You Have High Blood Pressure?
No
Yes
11)
Do You Floss Your Teeth?
No
Yes
12)
Do You Regularly Attend Religious Services?
No
Yes
13)
Do You Have High Cholesterol?
No
Yes
14)
Do You Have HIV/AIDS?
No
Yes
15)
How Do You Take Your Showers?
Cold
Moderately Cold
Mild
Moderately Hot/Warm
Hot
I don't take showers
16)
Do You Have Diabetes?
Type 1
Type 2
Type 1, but mildly
Type 2, but mildly
No
17)
Do You Suffer From A Serious Mental Illness?
No
Yes
I suffer from a mild mental illness
18)
What is Your Average Stress Level?
Low Stress
Moderate Stress
High Stress
19)
How Much Sleep do You Get?
8 hours
7 hours
9 hours
10 hours or more
6 hours or less
20)
What is Your Current Marital Status?
Married
Single, but expecting marriage
In a relationship
Single
Widowed, separated, or divorced
21)
Do You Meditate?
Yes, and often
Yes, and sometimes
No, but I'm not always panicky
No, and I'm often panicky
22)
Do You Often Practice Your Religion?
Rarely
Not very much
Kind of
Yes
Yes, very often
