Male Questionnaire
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PAST MEDICAL PROCEDURES

This section deals with invasive, manipulative or reparative physical procedures that have been carried out on your body.

Q849

Have you received any blood transfusions?
  • No / don't know
  • Yes, one
  • Yes, several

Q850

Have you ever had any type of surgery? For example, transplant surgery, weight loss surgery, tonsillectomy, appendectomy, splenectomy, small bowel resection, colectomy, mastectomy, hysterectomy, vasectomy, prostatectomy.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

LABORATORY VALUES – COMMONLY KNOWN

These values – if known – will help to confirm or rule out certain conditions.  Skip questions you are uncertain of, as well as older tests that are no longer valid.

Q851

Blood Pressure. What is your usual blood pressure without medication? [Top number, systolic]
  • Don't know
  • Under 110 (low)
  • 110 to 129 (normal)
  • 130 to 150 (elevated)
  • Over 150 (very elevated)

Q852

Blood Pressure. What is your usual blood pressure without medication? [Bottom number, diastolic]
  • Don't know
  • Under 70 (low)
  • 70 to 89 (normal)
  • 90 to 100 (elevated)
  • Over 100 (very elevated)

Q853

If you have hypertension (elevated blood pressure), how long has it been elevated? Don't include periods where it was normalized by medication or other means.
  • Not applicable / don't know
  • Less than two years
  • 2 to 6 years
  • 6 to 10 years
  • More than 10 years

Q854

What is your resting pulse rate? While at rest, hold two fingers under your wrist below the base of your thumb until you can feel your pulse. Count the number of beats in 15 seconds and multiply this number by 4.
  • Don't know
  • Under 60 beats per minute
  • 60 to 70
  • 71 to 80
  • Over 80 beats per minute

Q855

Have you had any laboratory or other diagnostic tests in the past year? Examples are blood, urine, stool, hair or saliva analysis; X-rays; scans; biopsies. NOTE: We do not require this information, but it can help to confirm or rule out certain issues.
  • Don't know
  • No tests within the past year
  • Yes, I have had tests within the past year*
* more questions will be asked later

FAMILY HISTORY

Q856

Do you have any knowledge of diseases/conditions that your parents, grandparents, brothers or sisters have had? Answer 'no' if, for example, you were adopted or simply have no idea.
  • No, I can't answer questions about close relatives
  • Yes, I can answer questions about close relatives*
* more questions will be asked later

CHILDHOOD

Q857

Did you ever have Chicken Pox as a child?
  • Don't know
  • Definitely not
  • Yes

Q858

Did you have childhood allergies or signs of allergy such as an "allergic crease" across the nose, runny nose or bags under the eyes?
  • No / don't know
  • Yes, but insignificant
  • Yes, a few minor ones
  • Yes, one or two severe
  • Yes, several severe

Q859

Were you inappropriately physically punished / abused as a child? Do not include sexual abuse here.
  • No / don't know / I deserved it and accept it
  • Mildly - an occasional smack
  • Moderately - regular light physical punishment
  • Occasional severe physical punishment/abuse
  • Severely - frequent hard physical punishment/abuse

Q860

Were you ever molested / sexually abused / raped as a child? Only include incidents that occurred up until the age of 18.
  • No / can't remember / don't know
  • There was occasional molestation
  • Frequent molestation and/or isolated serious abuse
  • Occasional serious abuse over a long period
  • Frequent serious abuse over a long period

Q861

Were you a hyperactive child?
  • No / don't know
  • Somewhat - I was more active than most children
  • Definitely - I was a 'real handful'
  • Severely - I was out of control

Q862

Have you had some or all of the 'required' vaccinations?
  • Don't know
  • I have not been vaccinated at all
  • I have had vaccinations but will not have any more
  • I have had vaccinations and may have more
  • Yes, and I am careful about keeping up-to-date

Q863

Puberty. Compared to your peers (other children of similar age, race and circumstances), did puberty for you begin early or late? The first physical signs of puberty are usually pubic hair development, then facial/body hair and voice change.
  • It started well over 1 year before my peers
  • It started about a year before my peers
  • It was about average / normal / don't know
  • It started about a year after my peers
  • It started well over 1 year after my peers
Report by The Analyst™
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PREVIEW: THIS PAGE WILL NOT BE SAVED
We need your:
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  • consent to collect data
  • name, age, and gender

Click here if you have already started the questionnaire and would like to continue.

Click here to start the questionnaire and receive your own detailed health analysis.

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