Male Questionnaire
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Report by The Analyst™
Click to see sample report

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.


1a - Your email address (required)

Please check your email address carefully. If it is incorrect then you will not receive your report!

Your email address:
NOTE: To prevent emails from going to a 'spam' folder, we recommend adding our email address to your whitelist or address book, or sending a 'test' email to that address.

1b - Alternative contact method

If possible, please give us an alternative means of contacting you.

Alternative contact:
Enter an email address, phone number, or 'none'.

1c - Report format (optional)

Your report can be sent in HTML, ZIP or PDF format. If you are unsure which to choose, or are using a small screen, we recommend HTML.

  • HTML (Web Page), Recommended
  • WinZip® Compressed
  • Adobe® PDF

1d - Report password (optional)

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. PDF format. If you would like to prevent others from reading your report, choose a password.

(No password protection is available for HTML reports)
Password to protect your report:
(Please remember it!)


If you wish, a doctor of your choice can review your report before you receive it.

2a - Doctor requirement (optional)

You can request a specific doctor, gender of doctor, or type of doctor to review your report.

My doctor must be:
We will always meet this request. If you have a very specific requirement, please contact us after completing the questionnaire.

2b - Doctor preference (optional)

An additional doctor preference can be selected here.

I would also prefer:
We will make every effort to also meet this request, but our doctors' schedules may prevent this.


Your approximate height and weight measurements indicate your body type and affect certain risk factors.

3a - Your height (required)

Enter your approximate height in feet-and-inches or centimetres.

Your height:
Enter feet or centimetres


3b - Your weight (required)

Enter your approximate weight in pounds, kilogrammes or stones.

Your weight:
Enter pounds, kg or stones



3c - Your main concerns (optional)

What are your main health concerns?

Please list up to 5 issues

3d - Medical history (optional)

List any major medical events in your life, such as hospitalizations or surgeries.

Please state the year if possible

3e - Current medications (optional)

List the drugs/medications that you are currently taking.

Mention any drug allergies that you have

3f - Other important information (optional)

Is there anything else that we need to know?

Mention anything not covered previously

4.  FINALLY...

4a - Your geographical location (required)

Please tell us where you live.

State / Region: (required if in USA)
City / Town:

4b - How did you find us (optional)

How did you discover our web site?

We would appreciate this information!

4c - Your occupation (optional)

What is your occupation?

If you are retired, what type of work did you do before?

4d - Further comments (optional)

Do you have any comments or suggestions?

Compliments, complaints or suggestions are welcome