Anti Aging Questionnaire

Anti Aging Questionnaire
How Well Are You Aging?

Please answer the anti aging questionnaire first before requesting your personal anti aging program.

To find out at which rate you are aging and if a anti aging program is appropriate for you, answer these questions.

1.	I feel like I have aged	+2
2.	I have trouble maintaining my ideal weight	+3
3.	My body fat percentage has increased	+3
4.	My cholesterol has increased	+2
5.	My HDL cholesterol has increased	+3
6.	My LDL cholesterol has increased	+3
7.	Although I'm active, my muscle tone has decreased	+2
8.	My strenght and stamina has decreased	+1
9.	I have more aches and pains	+1
10.	My desire for sex has deminished	+3
11.	In general, my energy levels have decreased	+2
12.	I have trouble sleeping	+1
13.	My vision is not as good as it was	+1
14.	I feel depressed and anxious once a week	+1
15.	I have more trouble concentrating than I used to	+2
16.	My memory is not as good as it used to be	+2
17.	I am loosing my hair	+2
18.	My skin is more dry and wrinkled than it used to be	+3
19.	I have developed osteoporosis	+3
	TOTAL SCORE

TOTAL SCORE	RESULT	ANTI AGING PROGRAM
Less than 9	You don't show signs of aging but you could benefit from anti aging treatment to delay the aging process.	Request Anti Aging Program
9 - 20	You appear to be showing early signs of aging. Now would be an excellent time to begin to start anti aging therapy to slow down the degenerative process.	Request Anti Aging Program
21-30	You are showing symptoms that would most likely benefit from an individualized treatment program.	Request Anti Aging Program
31+	You appear to be suffering from aging-related disorders. Further evaluation and treatment is recommended.	Request Anti Aging Program