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.
The following information will not be divulged in any form to any third party.
Items in red are required.
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If possible, please give us an alternative means of contacting you.
Your report can be sent in
If you are unsure which to choose, or are using a small screen, we recommend HTML.
Your report will be sent in
HTML format. If you require password protection, please select ZIP or PDF format above.
ZIP format. If you would like to prevent others from reading your report, choose a password.
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You can request a specific doctor, gender of doctor, or type of doctor to review your report.
An additional doctor preference can be selected here.
Enter your approximate height in feet-and-inches or centimetres.
Enter your approximate weight in pounds, kilogrammes or stones.
What are your main health concerns?
List any major medical events in your life, such as hospitalizations or surgeries.
List the drugs/medications that you are currently taking.
Is there anything else that we need to know?
Please tell us where you live.
How did you discover our web site?
What is your occupation?
Do you have any comments or suggestions?