Step 1 of 3 General Assesment Your responses to the following general health questions will provide us with the necessary information regarding your current health status, health concerns and lifestyle choices that will enable us to build your personal health evaluation. The questions highlighted in red require answers.       General   First Name:   Last Name:   Email:   Age:   Sex: M F   Height:  ft.  in.   Weight:  lbs.   BMI:  What is BMI? Lifestyle   Do you have a general feeling of good health? YesNo   Do you have a general feeling of poor health? YesNo   Are you a smoker? YesNo   Have you ever smoked? YesNo   When did you quit? N/A < 1 1 2 3 4 5 6 7 8 9 10> 10  years ago   Do you drink alchoholic beverages? Yes  No   How often do you drink? n/a Minimal Intake Moderate Intake Heavy Intake Exercise   Do you exercise? Yes No   Do you exercise more than three times per week? Yes No   Do you exercise less than three times per week? Yes No   What type of exercise? (Choose all that apply) Weight Lifting Aerobics Yoga Pilates Court Games Hiking Biking Walking Running Swimming   Do you do some form of cardiovascular (aerobic) exercise three times per week for at least twenty minutes per session? Yes No   Why do you exercise? (Choose all that apply) Weight Loss Stay Healthy Feels Good Weight Gain Diet   Are you a vegetarian? Yes No   Are you a diabetic? Yes No   If you are diabetic, what type? Type 1 Type 2 n/a   Does your diet include "junk food" more than twice a week? Yes No   Are you following a doctor recommended diet? Yes No   What diet? Select Diet Anne Collins Diet Atkins Diet Beverly Hills Diet Blood Test Diet Body For Life Diet Cabbage Soup Diet Carb Addicts Diet Caveman/Paleolithic Celebrity Diets Cider Vinegar Diet Dash Diet Diet Divas Diet Workshop Eat Right 4 Your Type eDiets Fasting & Diet Fasts Fat Flush Diet Plan Fit For Life Diet Food Combining Grapefruit Diet Herbalife High Protein Diets Hip and Thigh Diet Hollywood 48 Hour Jenny Craig LA Weight Loss Lean for Life Diet Liquid Diets Low Calorie Diets Low Fat Diets Low Fat Diets Review Low Fat Diets Study Mayo Clinic Diet Medifast Diet Mediterranean Diet Metabolife Negative Calorie Diet No Carb Diet Nutri/System Ornish Diet Overeaters Anonymous Peanut Butter Diet Peel Away the Pounds Perricone Diet Pritikin Diet Protein Power Diet Raw Foods Diet Rice Diet Program Richard Simmons Diet Scan Diet Scarsdale Diet 6 Week Body Makeover Skinny Pill SlimFast South Beach Diet Suzanne Somers Diet Subway Diet Sugar Busters Diet TOPS Total Health Makeover Weight Watchers Diet Zone Diet   Do you crave sweets and sugar? Yes No   Are you trying to lose body fat? Yes No   Are you trying to gain muscle? Yes No   Is your diet high in fiber? Yes No   Do most of the foods you eat come pre-prepared? Yes No Current Health Conditions   Do you currently have, or are you concerned about, any of the following conditions? Check all that apply.   Acne Allergy Anxiety Arthritis Asthma Athlete's Foot Canker Sores Carpal Tunnel Syndrome Chronic Fatigue Syndrome Cold Sores Constipation Depression Diet & Weight Loss Erectile Dysfunction Fibromyalgia Syndrome Genital Herpes Gingivitis Hair Loss Heartburn & Indigestion Hemorrhoids High Cholesterol Hot Flashes Insomnia Macular Degeneration Menopause Migraine Nutritional Anemia Osteoporosis Premenstrual Syndrome Prostate Health Rheumatoid Arthritis Skin Health Stretch Marks The Common Cold Type 1 Diabetes Type 2 Diabetes Vaginal Dryness Varicose Veins

Sponsored By:

		Copyright © 2004 Olympian Labs, Inc.

1-800-473-5883

Home | Take Our Online Health Evaluation | Research a Condition | Ask a Nutritionist

About this Site | Contact Us | Sponsors | Privacy Policy | Terms of Use