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What is your first name for our calculator?

Please enter your First Name.

Share your zip code for unique environmental factoring.

Questions

1
What is your date of birth?
Month Day Year
Please enter a valid date of birth.
2
Gender
3
Hopefully you are not a smoker. Which best describes your cigarette smoking habits?
4
How tall are you?
Feet Inches
Please enter your height.
5
How much do you weight (in pounds)?
Be honest - no one else will know.
Please enter your weight.
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Questions

6
Which describes your heart history?
7
Have you ever had a stroke?
8
Do you have high blood pressure?
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Questions

9
Do you have high cholesterol?
10
Do you have diabetes?
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Questions

11
Which best describes your drinking habits?
12
Which best describes your drug use?

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Your answer does not compute.
Please rethink that answer and select again.

*If you have a problem with substance abuse, expert help is available to ensure you gain control. Call 1-800-622-HELP in the U.S. now to begin the process of change.

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Questions

13
How often do you go to the doctor?
14
Which best describes your biological parents' longevity?
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Questions

15
Which best describes your level of physical activity?
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Questions

16
Which best describes your level of intellectual and social activity?
17
Which best describes your diet?
18
Which best describes your emotional outlook?
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Questions

19
How do you handle stress?
20
Which best describes your sexual activity?
21
Do you own a life insurance policy?

You're done!

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