What is your gender and age?

Male:
1-44 years old
45-55 years old 
56-65 years old
66-75 years old
75+ years old

Female:
1-54 years old
55-65 years old
66-75 years old
75+ years old

Do you smoke?

Never smoked or have been a non-smoker for 5 or more years
Smoked for less than 10 years or been a non-smoker less than 5 years
Smoker for 10-20 years
Smoker for over 20 years

Do you have a history of hypertension?

No history of hypertension 
Treated hypertension; BP average below 135/85 
Treated hypertension; BP average above 135/85 
Untreated hypertension; BP usually above 135/85

What is your total cholesterol level?

Below 200 
200-240 
Above 240

What is your level of LDL ("bad") cholesterol?

Below 100
100-130 
Above 130

What is your level of HDL ("good") cholesterol?

Male:
Above 50
35-50 
Below 35 

Female: 
Above 60 
45-60 
Below 45

What is your triglyceride level?

Below 100
100-150
Above 150

Do you have diabetes?

Absent
Adult onset, treated with diet alone
Adult onset; treated with pills and/or insulin 
Juvenile onset; insulin dependent

What is your exercise level? (aerobic exercise, at least 30 minutes per session)

3 or more times per week 
1-2 times per week 
0 times per week

How would you rate your stress level?

I don't feel stress 
I feel stressed 1-2 times per week 
I feel stressed most days 
I feel stressed everyday

What is your Body Mass Index (BMI)? (Click here to find your BMI) 

Below 25 
25-29.9 (overweight) 
Above 30 (obese) 
Above 40 (severe obesity)

Do you have a family history of heart disease?

No family history 
One family member 
More than one family member