YOUR Biological Age Questionnaire

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Click here to know more about what The Biological Age is

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What is Your Biological Age?
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Your Biological Age reflects your internal health as well as the lifestyle choices you’ve made that have affected your health today.
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The difference between your Biological Age and your chronological age can be used as a guide in making new lifestyle choices to regain and maintain optimal health and well-being.
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The Biological Age Questionnaire here has been modelled after the Biological Terrain Analysis (BTA). This questionnaire gives an inner profile of your body’s age. It measures the extent of any and all internal damage your body has accumulated and undergone in its life time.
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In order to give an accurate measurement of your Biological Age, it is imperative that you answer each question as honestly and as accurately as possible. (No one needs to know except you…so don’t tell any one!)
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This Biological Age Questionnaire is easy to follow. So go on, do it. Take the time and complete it.
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YOUR Biological Questionnaire here is divided into 6 sections:

Chronological Age
Dietary Choices
Dietary Supplementation
Daily Activities
Medical History
Stress

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Take your time to do the questionnaire and to be as accurate as possible in your answers ~ the more accurate your answers, the more accurate your results.
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SECTION A ~ Chronological Age
X

1. What is your current age (in years)?

Section A: Total Score _________
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SECTION B ~ Dietary Choices
X

2. How frequently do you consume grilled, fried or barbecued foods?

Often: 4
Once a day: 3
A few times/week: 2
Once/week: 1
Almost Never: -2
x

3. How often do you eat cold-pressed nutritional oils (not heated or fried)?
(Example: cold-pressed flaxseed oil)

Never: 2
Once a Week: 1
Once a Day: 0
2+ Times a Day: -1

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4. How many servings of fruits and vegetables do you eat?

Almost Never: 3
A Few times/week: 2
Once/Day: 1
3/day: -1
5+/day: -2
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5. How often do you eat whole grains and/or fibre?
(eg. brown/wild rice, whole wheat)

Almost Never: 3
Once / week: 2
A Few Times/Week: 1
Often: -2

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6. How many glasses of water do you drink per day?
(this does not include coffee, alcohol, soft drinks, soda, fruit juice, black tea)

Almost Never: 3
Once / Day: 2
4 per Day: 1
8 per Day; 0
10+ per Day: -2
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7. Do you consume sugar, white flour, soft drinks, soda, or any other processed foods?
(Example: fast food, canned food, TV dinners. foods with preservatives)|

3+ times/day: 3
Once/day: 2
A Few Times/week: 1
Almost Never: -1
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8. How many alcoholic drinks do you consume per week?

12+/Week: 3
8 per Week: 2
4 per Week: 1
2 per Week: 0
Almost Never: -1
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9. How often do you add salt to your food?

All Food: 3
Daily: 2
Few Times/Week: 1
Once /Month: 0
Almost Never: -1

Section B: Total Score _________

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SECTION C ~ Dietary Supplementation
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10. Do you take a multi-vitamin?

Almost Never: 2
Once A Week: 1
A Few Times/Week: 0
Daily: -1
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11. Do you take an Anti-Oxidant? (Example: Selenium, Grape Seed Extract)

Almost Never: 3
Once A Week: 2
A Few Times/Week: 1
Daily: -2
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Section C: Total Score _________

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Section D ~ Daily Activities
X

12. Do you exercise? (should be 30 minutes or more continuously with no stops)

Almost Never: 3
Once/Week: 2
3 Times/Week: -2
5+ Times/Week: -3
x

13. When exercising, does your session exceed 2 hours?
(If you don’t exercise, put ‘0…zero’ as your answer)

Most Times: 4
50% of The Time: 2
Almost Never: 0
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14. Do you sleep soundly and well? And awake feeling rested?

Almost Never: 3
Sometimes: 2
Usually: 0
Always: -1
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15. How frequent are your normal bowel movements?

Once A Week: 4
Every 4 Days: 3
Every 2 Days: 2
Daily: 0
2+ Times/Day: -2
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Section D: Total Score _________

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Section E ~ Medical History
X

16. Family Medical History: How many of the following health conditions exist in your family?
Cancer, Diabetes, Depression, Heart Disease, Obesity, Liver Disease, High Cholesterol, High Blood Pressure.

2 or more: 1
One: 0
None: -1
1

17. Do you suffer, or have you suffered previously, from the following conditions?
Cancer, Diabetes, Depression, Heart Disease, Obesity, Liver Disease, High Cholesterol, High Blood Pressure.

2 or More: 3
One: 2
None: -2
3

18. How often do you suffer from the following conditions?
Headache, Fever, Colds or Flu, Rashes, Swelling, Fever, Sore Throat, Muscle Aches (not exercise-induced)

Once A Day: 3
Once A Week: 2
Once A Month: 0
Almost Never: -1
3

19. Have you ever been exposed to toxic substances or to heavy metals?
Examples are, if you have been in these professions: Hair Dressing, Mechanics, Beauty, Dentistry, Oncology

Daily: 4
Weekly: 3
Monthly: 2
Almost Never: 0
4

20. Have you ever had exposure to heavy metals ~ via dental work and/or dental fillings?
Examples are mercury fillings, silver fillings and any other metal fillings.

3+ Fillings: 4
2 Fillings: 3
1 Filling: 2
Never: 0
4

Section E: Total Score _________

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Section F ~ Stress
X

21. How many full meals do you eat a day?
(A snack is not considered a full meal.)

Never: 3
4+ A Day: 3
3 Per Day: 0
2 Per Day: 1
1 Per Day: 2
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22. How often are you in front of electronic equipment (at home or at work)? Examples are computers, live cameras, television and electrical wires.

8+ Hours/Day: 3
6+ Hours/Day: 2
A Few Hours/Day; 1
Almost Never: 0
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23. How often are you exposed to cigarette smoke, direct or second-hand?

All Day: 4
A Few Times/Day: 3
A Few Times/Week: 1
Almost Never: -1
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24. Do you use, or have you used in the past, recreational or street drugs?

2+ Times/Day: 4
Once/Day: 3
Once/Week: 2
Once/Month: 1
Never: 0
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25. Do you drive in heavy traffic?

For A Living: 3
Daily 3+ Hours: 2
Daily 1 to 2 Hours: 1
Almost Never: -1
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26. Do you experience stress at home and/or at work?

Very High: 4
High: 3
Moderate: 2
Slight: 1
Almost None: -2
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Calculating Your Biological Age

Add all the 6 scores from Sections A to F to obtain your Biological Age.

Section A: Chronological Age: _____
Section B: Dietary Choices: _____
Section C: Dietary Supplementation: _____
Section D: Daily Activities: _____
Section E: Medical History: _____
Section F: Stress: _____

GRAND TOTAL: ____