How long will I live?

Fill in the following form. You do not need to fill in all answers, but you must enter your age and click the button labeled "score test".

Age

• years
Sex

• female
• male
Race

• white
• black
• other
Marital status

• married
• single
Smoking

• cigarettes per day
Exercise

• minutes per day
Driving

• miles per day Wear seat belt?
• no yes
Flying - commercial airlines

• miles per year
Flying - hobby (miles per year):

• miles per year
Motorcycle?
Bicycle?
Wear helmet?
Sexual preference (M/F)

• male
• female
Number of unprotected sexual acts per month

• heterosexual acts
• homosexual acts
Weight

• pounds
Height

• inches
Fat consumption (% of calories):
Fruits and vegetables (servings per day):
Keep a handgun in the house:
Hang gliding (flights per year):

To clear the form, press this button: .