BioAge Questionnaire

What is your gender? Male Female

What is your date of birth?

Race/Ethnicity: Hispanic Caucasian African East Asian Eurasian South Asian Pacific Island Other

Total number of people in your household:

How many rooms are in your home? Count the kitchen but not the bathroom.

What is the highest grade or level of school you have completed or the highest degree you have received? Less than 9th grade 9-11th grade High School Graduate/GED or equivalent Some college or AA degree College graduate or above

About how long have you worked for your current employer in months? (Enter 0 if unemployed)

About how long was the longest job that you were employed in, in months?

Up to the present time, what is the most you have ever weighed?

How much did you weigh at age 25? (Enter current weight if you are under 25)

What is your arm circumference (cm)?

What is your systolic blood pressure?

What is your diastolic blood pressure?

Have you had shortness of breath either when hurrying on the level or walking up a slight hill? Yes No

Have you smoked at least 100 cigarettes in your entire life? Yes No

Three-part question: Part 1 - In the past 12 months, how often did you drink any type of alcoholic beverage? (How many days per week, per month, or per year did you drink?)

Part 2 - Unit of Measure Week Month Year

Part 3 - On those days that you drank alcoholic beverages, on the average, how many drinks did you have?