Longevity Questionnaire – OLD Step 1 of 6 16% PhoneThis field is for validation purposes and should be left unchanged.Health Care (1 out of 6)Do you smoke?(Required) yes quitted more than a year ago quitted more than 10 years ago quitted smoking more than 15 years ago no, never How many servings of alcohol on average do you drink per week? 1 serving is a glass of wine or a can of beer(Required) 0 to 2 2 to 5 above 5 How often do you arrange check-ups with blood work with your healthcare provider?(Required) every 6 months annually once in 2 years at longer intervals Are you proactive in seeing a doctor when you feel sometihng is wrong?(Required) yes no Do you use any type of wearables to help with tracking your health?(Required) yes no How regularly do you engage in thermal activities like using a sauna, cold plunge, or taking cold showers?(Required) Never Once a month Once a week More than once a week Exercise (2 out of 6)How much total time per week do you spend on activities that raise your heart rate?(Required) less than 1 h 1 – 2,5 h 2,5 h – 4 h 5 h or more How much time you spent doing strength training, like lifting weights or resistance bands?(Required) none 10-30 mins below 1h 1.5 h – 2 h more than 2 h How much time you spent doing exercises to improve balance, like yoga, tai chi, pilates?(Required) none 1 h 2 h or more Do you include stretching exercises before or after your workout?(Required) yes no Third Choice Nutrition (3 out of 6)What is you height?(Required)What is your weight?(Required)How many times per week do you consume pre-packaged or fast food meals?(Required) More than 5 times a week 4-5 times a week 2-3 times a week Once a week or less Never How many ounces (oz) or liters (L) of water do you drink daily?(Required) Less than 35 oz ( 1L) Less than 75 oz (2L) 75 oz (2L) or more Are you currently using any health or longevity supplements?(Required) yes no How many total hours per day are you fasting, including sleep time?(Required) 8 h or less 9-11 h 11-12h more than 13 h Sleep (4 out of 6)How would you rate your sleep quality overall?(Required) Very good Fairly good Fairly bad Very bad How many hours of sleep do you usually get every night?(Required) Below 6h 6- 7 h 7-8 h 8-9h How many times do you wake up at night on avearge?(Required) 0-2 2-3 more than 3 How many days during the week do you go to bed and wake up at the same time?(Required) 5 to 7 3 to 5 below 3 How many times a week do you use sleep medication?(Required) 4 days or more 2-3 days once a week never Do you have a relaxing bedtime routine?(Required) yes no Do you feel that your bed, noise level and temperature provide an optimal sleep environment?(Required) yes no Mindset (6 out of 6)During last 2 weeks how often did you feel down, depressed, or hopeless?(Required) never 1 to 6 days 7 or more days How often a week do you meditate or practice mindfulness?(Required) never 1-2 times a week 3-5 times a week every day How many hours per week do you spend on hobbies or activities that bring you joy?(Required) less than 1 h a week 1-2 h 3 h or more How often a week do you meet with family or friends?(Required) 1-2 times a week 3-4 times a week 5 or more How regularly do you engage in conversations where you openly share your feelings with someone you trust?(Required) I don’t, I keep my feeling to myself. Rarely. Only in exceptional circumstances Sometimes. When prompted or during significant life events Frequently. It’s a regular part of my interactions How active are you in community groups?(Required) Not involved I occasionally participate I regularly attend or contribute I am a key member or organizer How often do you engage in brain-stimulating activities, such as puzzles, chess, or learning new language?(Required) Rarely or never Weekly Several times a week Mental Health (5 out of 6)How much do you feel age restricts you from achieving personal goals and leading a fulfilling life?(Required) I feel age somewhat restricts me. Age has minimal impact on my goal achievement or life fulfillment. I don’t see age as a barrier to my personal goals or happiness Until what age do you foresee maintaining an active lifestyle? (answer in number)(Required)Do you consider yourself a positive person?(Required) Yes, I am generally optimistic. Neutral, I have a balanced outlook. No, I tend to be more pessimistic. Do you set goals and prioritize activities that promote your overall well-being and longevity?(Required) Yes, regularly and consistently Sometimes, but not consistently Rarely or never How easily do you find purpose and meaning in your everyday life?(Required) With difficulty Somewhat easily Quite easily Are you part of a community that encourages a focus on long-term health and well-being?(Required) yes no Share what you've learned!
