You will be redirected in few seconds.
You will be redirected in 10 seconds.
Help us gather insight on your health
Click here to get started
How old are you?
65 or over
What is your gender?
What is your ethnic background?
Black or African American
Hispanic or Latino
How would you rate your physical health?
How would you rate your overall mental/emotional health?
How would you rate your stress levels?
Do you have any chronic health conditions?
Please specify your chronic health conditions
Do you have any hereditary conditions/diseases?
High Blood Pressure
Please specify your hereditary conditions/diseases
Do you smoke or use tobacco products?
How often do you consume alcohol?
How would you rate your level of physical activity?
How many hours of sleep do you typically get per night?
Less than 5 hours
More than 10 hours
Have you experienced any significant weight changes in the past year?
Do you have any allergies?
How often do you visit your primary care physician?
Once a year or less
2-3 times a year
4-6 times a year
More than 6 times a year
Have you ever been admitted to the hospital?
Please specify your reason for hospitalization
Do you have health insurance?
If you do not have health insurance, why not?
Can’t afford it
Don’t think I need it
Don’t know how to get it
Please share any additional comments or concerns regarding your health
Thank you for your feedback.
Choose a Country Code
No code found as per your search