1. How much sleep do you get each night?
  2. Do you smoke?
  3. Do you drink more than three drinks a week?
  4. Do you get at least a half hour of exercise, six days a week?
  5. Do you take a multivitamin regularly?
  6. Are you overweight?
  7. Do you floss your teeth daily?
  8. Do you like to drive fast?
  9. Have you driven drunk (or ridden with a drunk driver) in the past three years?
  10. Your relationship status is:
  11. Do you eat your fruits and vegetables?
  12. Do you eat breakfast?
  13. Do you suffer from depression?
  14. Do you practice safe sex?
  15. In general, you'd say your life is:
  16. Do you belong to a volunteer group or church you attend regularly?
  17. You consider yourself to be:
  18. Do you own a dog?
  19. Do you practice meditation or yoga?
  20. Your household income is: