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Gender

Marital Status

Health Check Preference

Smoking

Alcohol Consumption : > 3 drinks/week

Moderate alcohol use for healthy adults means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.(Examples of one drink include:Beer: 12 oz(355 ml),Wine: 5 oz(148 ml) , spirits 1.5 oz(44 ml))

Overweight or Obese (BMI>25)

Poor Fitness Level or Low Fitness Level

(exercise less than 2 hrs/week, feels breathless or tired, Struggle to balance or pain) *

Poor diet (>3 refined foods/day,Fried Food >2/week)

Personal Medical History


Family Medical History


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