Phase one of eight

11%

Medical Questionnaire 1 – Aging

Age of Parents

Is your mother younger than 80 years? *

Yes

No

Is your father younger than 80 years? *

Yes

No

Is your maternal Grandmother younger than 80 years? *

Yes

No

Is your maternal Grandfather younger than 80 years? *

Yes

No

Is your paternal Grandmother younger than 80 years? *

Yes

No

Is your paternal Grandmother younger than 80 years? *

Yes

No

Existing Diseases and Medicines Use

Do you have at least one medical check up with your physician every year? *

Yes

No

Is your blood pressure normal? *

Yes

No

Are your routine laboratory blood values within normal range? *

Yes

No

Is your blood sugar level in normal range (Diabetes Mellitus)? *

Yes

No

Do you have regular bowel movements (e.g. daily)? *

Yes

No

Do you take any hormones (e.g. birth control pills, estrogens, etc.)? *

Yes

No

Power Supply and Vital Substances

Do you eat at least 3 servings of fruits and vegetables per day? *

Yes

No

Do you take Vitamin C or eat food high in Vitamin C on a regular basis? *

Yes

No

Do you eat oily fish (e.g. salmon, trout or tuna) twice a week or more? *

Yes

No

Do you get high-quality, cold-pressed oils (e.g. olive, peanut or sunflower) in your daily diet? *

Yes

No

Do you avoid candy, sweets and other things made mostly of sugar? *

Yes

No

Do you avoid heavily salted or smoked food? *

Yes

No

Do you regularly eat food high in fiber? *

Yes

No

Do you drink at least a half-gallon of water daily? *

Yes

No

Weight

Does your weight fall in the normal range? (BMI 18.5 – 25)? *

Yes

No

Movement

Does your job, career, employment involve being active? *

Yes

No

Do you engage in 40 minutes of physical activity at least 3 times per week or go for a walk at least 5 times per week? *

Yes

No

Mental Activity

Do your daily tasks involve mental stimulation? *

Yes

No

Do you follow political and/or social issues? *

Yes

No

Do you do crossword puzzles or other forms of mental gymnastics at least once per week? *

Yes

No

Environmental Setting

Does your personal workplace include an abundance of technology like computers, printers etc.? *

Yes

No

Do you clean work spaces such as your home, car or office? *

Yes

No

Do you use protective gloves when doing so? *

Yes

No

Do you wash new clothes before putting them on? *

Yes

No

Do you prefer certified organic foods? *

Yes

No

Immune Training

Do you go to the sauna regularly? *

Yes

No

Is your daily shower hot? Or cold? *

Cold

Hot

Dental Hygiene

Do you brush your teeth at least three times a day? *

Yes

No

Do you floss your teeth daily? *

Yes

No

Sleep

Do you get between 6 and 8 hours per night sleep? *

Yes

No

Do you generally sleep undisturbed, without interruptions? *

Yes

No

Do you work during the day? *

Yes

No

Stress

Is your work mostly stress free? *

Yes

No

Do you have a steady income? *

Yes

No

Do you have a balanced family life (partner, family, children)? *

Yes

No

Ultra Violet Radiation

Do you avoid spending hours sun bathing? *

Yes

No

Do you avoid solariums/sun tanning rooms? *

Yes

No

Do you spend any time in the high mountains? *

Yes

No

Stimulants

Are you a non-smoker? *

Yes

No

Is your immediate environment (work, family, friends) smoke-free? *

Yes

No

Do you avoid hard alcohol (whiskey, gin, vodka, etc)? *

Yes

No

Do you drink red wine occassionally? *

Yes

No

Sex Life

Do you have a permanent sex partner? *

Yes

No

Do you have sex at least four times a month? *

Yes

No

Social Network

Are you living with a permanent partner or within a permanent family atmosphere? *

Yes

No

Do you have friends to enjoy activites with? *

Yes

No

Do you belong to any clubs or associations? *

Yes

No

Positive Thinking

Do you have one or more hobbies? *

Yes

No

Are you a positive-thinking person? *

Yes

No

Do you like to laugh? *

Yes

No