*What is your Name?
*What is your email
*How old are you?
*What is your gender?
Select your country
How tall are you (cm)?
What's your weight (kg)?
How big is your waist (cm)?
What is your ethnicity?
What is your level of education?
How many hours a day are you exposed to screens (smartphone, computer, TV)?
What is your marital status?
You live alone?
Do you consider yourself a happy person?
How many hours do you usually sleep per night?
How often do you experience stress at home or work?
Over the past two weeks, have you felt discouraged, depressed, or hopeless?
In the last week, did you exercise for 30 minutes or more a day?
Are you vegetarian or vegan?
How often do you expose yourself to the sun?
Do you use sunscreen?
Do you have or have you ever had any learning problems?
What is your usual alcohol consumption per week?
Do you smoke?
What is your systolic blood pressure? (Bigger number of measure)
Do you take medicine for pressure?
Do you have diabetes?
What is your total cholesterol level (mg/dL)? (Example: 199.3)
What is your HDL cholesterol level (mg/dL)? (Example: 51.4)
What is your creatinine level (mg/dL)? (Example: 1.02)
What is your total white blood cell count (/mm³)? (Example: 6130)
What is your red blood cell count (million/mm³)? (Example: 5.13)
What is your platelet count (per uL)? (Example: 255000)
What is your 25-hydroxy-vitamin D3 level (ng/mL)? (Example: 30)
What is your vitamin B12 level (ng/mL)? (Example: 300)
What is your triglycerides level (mg/dL)? (Example: 102.3)
What is your fasting blood sugar level (mg/dL)? (Example: 85.0)
Fracture or osteoporosis
Have you been admitted to a hospital last year?
How many times did you have an emergency trip last year?
Hormone replacement therapy
Nonsteroidal anti-inflammatory drugs (ibuprofen, aspirin, naproxen)
Valve heart disease
Chronic lung disease
Inflammatory bowel disease
Peripheral vascular disease
Chronic liver disease
Endocrine conditions (thyroid etc)
History of falls
Hip fracture or surgery
Depression or schizophrenia
Are you or your partner pregnant?
How would you rate your physical health compared to other people your age?
Sua inscrição foi aceita e logo você receberá o e-mail de confirmação.
Sua inscrição foi aceita e logo você receberá o e-mail com o link que deve ser repassado aos funcionários.
Lembramos que as informações de saúde contidas nos formulários dos colaboradores são de uso pessoal e intransferível desses e protegidos pelo que há de mais moderno em tecnologia de proteção de dados.
Vamos entrar em contato com você em breve!