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Male Longevity Diagnostics Screening Questionnaire

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Male Longevity Diagnostics Screening Questionnaire

This questionnaire helps assess if you may benefit from advanced health screening.
Please answer the following questions honestly.

Male Longevity Diagnostics Screening Questionnaire

Male Longevity Diagnostics Screening Questionnaire

GENERAL HEALTH

1. Do you experience frequent fatigue or lack of energy?
2. Have you been diagnosed with high blood pressure or hypertension?
3. Do you have a family history of heart disease or stroke?
4. Have you been diagnosed with high cholesterol or hyperlipidemia?
5. Do you smoke or have you smoked in the past?
SEXUAL HEALTH
6. Do you experience erectile dysfunction (difficulty achieving or maintaining an erection)?
7. Do you have a reduced interest in sex (low libido)?
8. Have you experienced any changes in sexual performance or satisfaction?

BONE HEALTH

9. Have you experienced any fractures or bone breaks in the past 5 years?
10. Do you have a family history of osteoporosis or other bone diseases?

VASCULAR & ENDOTHELIAL HEALTH

11. Do you have a history of diabetes or high blood sugar levels?
12. Have you been diagnosed with any vascular diseases (e.g., peripheral artery disease)?
13. Do you experience frequent leg cramps or pain while walking?

CANCER RISK

14. Do you have a family history of cancer?
15. Have you noticed any unexplained weight loss or changes in appetite?
16. Do you have any unusual lumps or bumps on your body?

LIFESTYLE & STRESS

17. Do you exercise regularly (at least 30 minutes, 3 times a week)?
18. Do you follow a balanced diet with plenty of fruits, vegetables, and whole grains?
19. Do you experience high levels of stress in your daily life?
20. How many hours of sleep do you get on average per night?

Scoring Instructions:

Scoring


– General Health: 1 point for each Yes
–  Sexual Health: 1 point for each Yes
–  Bone Health: 1 point for each Yes
–  Vascular and Endothelial Health: 1 point for each Yes
–  Cancer Risk: 1 point for each Yes
–  Lifestyle and Stress: 1 point for each No in questions 17 and 18, and 1 point for each Yes in questions 19 and 20


Total Score: _______ / 20


Results


– 0-5 Points: Low Risk – Routine health checks and maintaining a healthy lifestyle are recommended. Advanced screening may not be necessary at this time.
– 6-10 Points: Moderate Risk – Consider discussing with your healthcare provider about more detailed health assessments and monitoring. Advanced screening might be beneficial.
– 11-15 Points: High Risk – It is recommended to undergo comprehensive health screening to evaluate your overall health and prevent potential health issues.
– 16-20 Points: Very High Risk – Immediate consultation with a healthcare professional is recommended. Comprehensive health screening is highly advised to identify and manage health risks.

Next Steps


If you scored 6 or higher, we recommend scheduling a free counselling with team member
of Ankur Urja to discuss your results and determine the best course of action for your health.

Get Expert Advice on Your Score – Book a Free Counselling with Our Specialist Counsellor Today!

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