 | How old are you? | |
| How often do you smoke? | |
| Choose the option that best describes your diet. | |
| Have you ever had a hernia? | No Yes |
| How tall are you? | |
| How often do you drink alcohol? | |
| Please choose the option that best describes your body type. | |
| Do you have any rare medical disorders, such as elephantitis? | No Yes |
| Are you an albino? | No Yes |
| Do you have any kind of hindered mobility - such as having a prosthetic limb or being paraplegic? | No Yes |
| Have you ever had your appendix removed? | No Yes |
| Choose the option that best describes the hair on your head. | |
| How is your vision? | |
| How frequently do you take pain relievers such as advil, ibuprofen, or codeine? |
- Name That Drug! - |
| How much exposure do you have to the sun? | |
| Do you work in an environment where you might be exposed to noxious chemicals, such as lead or asbestos? This includes those who work with ceramics, lead, or processed materials. | |
| Do you regularly drink beverages high in sugar, such as soda or energy drinks? | No Yes |
| Have you ever been prescribed any anti-psychotic medication, such as lithium or seroquel? | No Yes |
| Have you ever had any serious surgery, such as heart or intestinal surgery? | No Yes |
| Are you diabetic? | No Yes |
|
