Biological Age & HealthSpan Report

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You are requesting for a health and longevity report from FastFitness Labs. The more honest your answers, the more accurate the report. Anything blank will be treated as "average" in calculations

Email *

Gender

Male

Female

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How did you find this form? *

Random search

By invitation from FastFitness

From a friend

Other:

Date of Birth

YYYY

City and Country of Residence *

Country where you live (or spend most time)

Weight (and is that in kgs or lbs?)

Height (and is that in m or feet?)

If you know it, what is your waist circumference? (state units pls) *

What do you want to know? *

Most interested

A little curious

I don't want to know

My biological age

My expected longevity

Predicted healthy years remaining

Effect of modifiable risk factors

Tell us a bit about yourself, especially your main area of work (profession) *

Please Rate Your Overall Health

How Many Days do you Work (per week) *

Include any paid work for employer / type "retired" if applicable

Retirement Age *

What age do you plan to (or did you previously) retire from work? if unsure enter "65" if not applicable enter "99"

Quick Risk Factor Screen *

A little

A lot

Smoking

Alcohol

Processed Food

Take-away or restaurant meals

What type of work do you do?

...and how do you feel about it?

Feel Satisfied/valued

Neutral

Unsatisfied or overworked

Work for an Organization

My own boss (eg own business)

Family responsibilities

Retired or not working

Clear selection

Resting Heart Rate (optional)

This is your lowest heart rate when calm, sitting or lying down

Sleep (average hours per night) *

if sleep quality is an issue, please describe

Look Up Pollution Near You Using: https://waqi.info/

optionally, find the particulate score (PM2.5) where you spend most of the time (range 5-999) or just type pollution = low/medium/high

Moderate exercise per day (on average) in MINS *

Exercise such as walking and housework and gardening and also yoga

Strong exercise per day (on average) in MINS *

This activity which increases heart rate significantly (eg jogging, cycling, swimming, rowing, sports, weights)

Predominant Exercise Intensity

How hard do you push when you exercise? If it varies, then describe hardest 20% of sessions

High (running, competitive sport, cycling events)

Medium (casual sport, gym class)

Low (eg walking, golf, yoga)

Mental Health and Stress

Never

In the past

Ongoing

Regular stress or worry

Anxiety, depression or panic

Other serious mental health

Addiction

Memory or cognitive issues

Detailed Dietary Screen *

Never or Almost never

A little

Regularly / A lot

Red meat (beef / lamb) or Pork

Chicken (or any poultry)

Fish (non-battered, plain)

Rice or Potatoes or Bread

Packaged Cereal or Refined Oats

Dairy milk or eggs or cheese

Biscuits or cakes or crisps or snacks

Fruit and Vegetables and Salad (see below)

Coffee or caffeine

Added salt (or Hidden salt)

Added sugar or sweetners

Palm or unsaturated oils

Lentils, peas, dry beans, soy

Nuts

Cook at home from ingredients

Eat out (restaurants)

Take-aways

Never or Almost never

A little

Regularly / A lot

Red meat (beef / lamb) or Pork

Chicken (or any poultry)

Fish (non-battered, plain)

Rice or Potatoes or Bread

Packaged Cereal or Refined Oats

Dairy milk or eggs or cheese

Biscuits or cakes or crisps or snacks

Fruit and Vegetables and Salad (see below)

Coffee or caffeine

Added salt (or Hidden salt)

Added sugar or sweetners

Palm or unsaturated oils

Lentils, peas, dry beans, soy

Nuts

Cook at home from ingredients

Eat out (restaurants)

Take-aways

Fruit and Veg Portions per day (80g = portion) *

(on average across a typical day)

Soft drinks (soda...includes low cal versions) per day *

(answer in mls if possible.....on average across a typical day)

Alcohol Per Day (average)

Never

x1-x2 per week

x1 per day

x2 per day

x3 per day

Beer or Larger or Cider@Pint

Red/White/Rose or Sparkling Wine@Glass

Spirits or Tequila or Liqueur @ Single

Red/White/Rose or Sparkling Wine@Half Bottle

Other alcohol

Smoking (per day average) *

Never

in the last 10yrs

in the last 5yrs

in the last 2yrs

Currently (see below)

Cigarettes

Cigar

Vape

Shisha

Other smoking

If you are smoking; how many per day?

Leave blank for zero or does not apply

Please describe your Family History *

Relationship Status

Medical History

Optionally describe them at the end of this form

Blood Pressure

Optionally,

If you know if what is your recent BP?

eg 140/85

Questions on Recent Stress *

Not a problem

This is a problem

Have you been able to concentrate on whatever you’re doing?

Have you lost much sleep over worry?

Have you felt you were playing a useful part in things?

Have you felt capable of making decisions about things?

Have you felt constantly under strain?

Have you felt you couldn’t overcome your difficulties?

Have you been able to enjoy your normal day-to-day activities?

Have you been able to face up to your problems?

Have you been feeling unhappy and depressed?

Have you been losing confidence in yourself?

Have you been thinking of yourself as a worthless person?

Have you been feeling reasonably happy, all things considered?

Have you been struggling with bills or money?

Not a problem

This is a problem

Have you been able to concentrate on whatever you’re doing?

Have you lost much sleep over worry?

Have you felt you were playing a useful part in things?

Have you felt capable of making decisions about things?

Have you felt constantly under strain?

Have you felt you couldn’t overcome your difficulties?

Have you been able to enjoy your normal day-to-day activities?

Have you been able to face up to your problems?

Have you been feeling unhappy and depressed?

Have you been losing confidence in yourself?

Have you been thinking of yourself as a worthless person?

Have you been feeling reasonably happy, all things considered?

Have you been struggling with bills or money?

Income Bracket in Your Country

Social life with family and friends *

How many times a week do you go out to meet friends/family? *

Comments or clarifications

Please describe anything we missed, or clarify any items above here

Thank you, submit for reply within 24 hours

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