Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.What is your smoking status?Multiple ChoiceNever smokedFormer smoker (quit >6 months ago)Current smoker (cigarettes per day: [1-5 | 6-10 | 11+])How would you describe your physical activity level?Multiple ChoiceSedentary (no exercise)Light (1-2 day exercise/week)Moderate (3-4 day exercise/week)Active (5+ days exercise/week) How would you describe your eating habits?Multiple ChoiceHealthy (balanced meals, plenty of vegetables)Moderate (mostly healthy with occasional junk food)Unhealthy (frequent fast food, high in processed foods)Do you consume Alcohol?Multiple ChoiceNeverOccasionally (1-2 drinks/week)Regularly (3+ drinks)Do you take blood pressure medication?Multiple ChoiceYes, taking regularly as prescribedYes, but sometimes skip dosesRecently stopped taking medicationNo, not prescribed any medicationWhat is your resting heart rate (beats per minute)?Number Slider Selected Value: 40 Do you experience chest pain during physical activity?Multiple ChoiceNever experience chest painRarely (once a month or less)Sometimes (few times a month)Often (weekly or more) describe night? level? Have you been diagnosed with hypertension (high blood pressure)?Multiple ChoiceYes (on medication)nonot testedHave you been diagnosed with diabetes?Multiple ChoiceType 1 DiabetesType 2 DiabetesnoprediabetesWhat is your stress level?Multiple ChoiceLow (Rarely feel stressed)Moderate (Occasionally feel stressed)High (Frequently feel stressed)How many hours do you sleep on average per night?Number Slider Selected Value: 1 Do you experience shortness of breath?Multiple ChoiceNeverDuring exertionAt restFamily history of heart diseaseMultiple ChoiceParent(s) had heart disease before age 55Sibling(s) had heart disease before age 65No family historyNot sureWhat are your cholesterol levels (if tested)?Multiple ChoiceTotal Cholesterol (mg/dL):HDL (“good” cholesterol):LDL (“bad” cholesterol):Not TestedSubmit