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What is your first name for our calculator?*

First

Share your zip code for unique environmental factoring.

1) What is your date of birth?*

Month

Day

Year

2) Gender*

Male

Female

3) Hopefully you are not a smoker. Which best describes your cigarette smoking habits?*

Gross. Never touch the stuff.

I smoke, but less than 5 cigarettes per week, but trying to quit. I

I smoke between 5 and 20 cigarettes per week. I know, I know ...

I smoke between 1 and 7 packs per week. This is hurting both my wallet and my lungs.

I smoke more than 7 packs per week. I have no plans to quit, so mind your own business.

4) How tall are you?*

Feet

Inch*

Inches

5) How much do you weight (in pounds)? Be honest - no one else will know.*

Please enter a number from 75 to 400.

6) Which describes your heart history?*

I have no history of heart disease.

I have been diagnosed with mild heart disease which is well-controlled. I have never had a heart attack.

I have been diagnosed with heart disease that is marginally controlled. I have never had a heart attack.

I have had a heart attack, but there are no residual symptoms. The underlying cause of my heart attack is well-controlled.

I have had a heart attack with residual symptoms and/or the underlying cause is not well-controlled.

I have had more than one heart attack with severe residual symptoms.

7) Have you ever had a stroke?*

Yes. I have no residual effects.

Yes. I have mild/moderate residual effects.

Yes. I have significant residual effects.

8) Do you have high blood pressure?*

I don't know. (Go get it checked. Knowledge is power.)

Yes. It is well-controlled with diet, exercise, and/or medication.

Yes. It is not well-controlled.

9) Do you have high cholesterol?*

I don't know. (Go get it checked. Knowledge is power.)

Yes. It is well-controlled with diet, exercise, and/or medication. Yay for me!

Yes. It is not well-controlled.

10) Do you have diabetes?*

Yes. It is well-controlled with diet and/or medication. I have no or only mild outward symptoms. I am not on insulin.

Yes. It is well-controlled with diet and medication. I have no or only mild outward symptoms. I am on insulin.

Yes. I have moderate outward symptoms.

Yes. I have severe outward symptoms.

11) Which best describes your drinking habits?*

I don't drink alcohol.

I drink seven (7) or less alcoholic beverages per week and no more than two (2) in one day.

I drink eight (8) to fifteen (15) alcoholic beverages per week.

I drink more than fifteen (15) alcoholic beverages per week.

12) Which best describes your drug use?*

No illicit drug use and no long-term use of prescribed narcotic pain-killers (Oxycodone, Hydrocodone, etc.).

I smoke marijuana occasionally.

I have been taking prescribed narcotic pain-killers for more than 6 months.

I regularly use cocaine, methamphetamine, non-prescribed narcotic pain-killers, heroin, or any other illegal drug besides occasional marijuana.

13) How often do you go to the doctor?*

I regularly attend preventative check-ups, including recommended screenings such as colonoscopies, mammograms, and prostate exams. I closely follow all medical directives.

I go to the doctor when I feel bad and generally follow medical directives when I go, but I am behind on one or more preventative screenings.

I never go the doctor, even when I am sick or hurt.

14) Which best describes your biological parents' longevity?*

Both parents lived beyond 85 years old.

One parent lived beyond 85 years old.

Both parents died before the age of 80 and/or one parent died before the age of 76 of cancer or heart disease.

Both parents are living happy and healthy lives.

I don't know.

Not applicable

15) Which best describes your level of physical activity?*

I average at least 30 minutes per day of vigorous physical activity.

I average at least 30 minutes per day of some type of physical activity.

I get some physical activity, but less than an average of 30 minutes per day. (Paying for the gym membership doesn't count.)

I get little or no physical activity. (I know I should, but...)

16) Which best describes your level of intellectual and social activity?*

I am quite active socially. I engage with family and/or friends daily.

I am not overly social, but I keep my mind active with reading, puzzles, school, or other mentally stimulating activity.

I am not very social and am often bored.

17) Which best describes your diet?*

I eat a well-balanced diet of healthy carbohydrates, protein, and healthy fats. I eat little or no processed food or refined sugar. Woo-Hoo!

I try to eat healthy, but I eat a moderate amount of processed food or sugar.

I eat mostly processed food. Don't judge me!

18) Which best describes your emotional outlook?*

I am usually a happy person. When I am sad, it is for a good reason and does not last long.

I am generally happy, but I am occasionally sad for no good reason. These feelings never affect my ability to perform regular daily activities.

My depression often affects my ability to perform regular daily activities.

19) How do you handle stress?*

I almost never let stress linger. I actively address the source of the stress and resolve it very quickly.

I am often stressed for long periods of time. This stress often interferes with my sleep, my relationships, and my happiness.

I am somewhere between the previous two choices.

20) Which best describes your sexual activity?*

I am abstinent.

I am in a long-term, monogamous relationship.

I have multiple sexual partners, but always engage in safer sex practices.

I have multiple sexual partners, and do not always engage in safer sex practices.

21) Do you own a life insurance policy?*

Yes

22) Would you like to have a current market appraisal completed so you can find out how much you policy may be worth?*

Yes

Your email here:*