How would you rate the level of stress at your work and/or your life in general?
High Moderate Low

How often do you get a cold, flu, sore throught, earache,or infaction in a year?
More than twice Twice Once Less than once

Do you smoke cigarettes, pipe, cigars, or other tobacco products?

Yes No

Do you have elevated blood presure or high cholesterol?
Yes No Don't Know

How often do you perform aerobic excercise?

Less than 1 / wk Less than 2 / wk
2-4 times / wk      More than 4 times / wk

How would you rate the quality of your hair, nails, and skin?
Poor Good Excellent

If you are a female, are you pregnant?
Yes No

Do you suffer from gallstones or any other gallbladder condition?
Yes No