Wellness Research Program Online Wellness Research Program By checking this field you agree to participate in GTC's Online Wellness Research Program Yes, I agree Your Name Your Surname Your Email Gender MaleFemaleRace/Ethnicity American Indian or Alaska Native onlyAsian OnlyNative Hawaiian or Other Pacific Islander onlyBlack or African American onlyWhite onlyHispanic or Latino2 or more racesEducation ---<High SchoolHigh SchoolSome CollegeAssociates Degree4-year College DegreeAdvanced DegreeFamily Income Thousands $ Family Type ---SingleSingle parent with children Married couple or partnersTwo parent family with childrenOtherCountry of Birth USOutside USDisability Status Without DisabilitiesWith DisabilitiesSexual Orientation Straight MaleStraight FemaleGay/LesbianBisexualMarital Status MarriedCohabiting PartnerDivorced or SeparatedWidowedNever MarriedDo You Currently Smoke? NoYesOccasionallyDo you have an immediate family member who has developed heart disease Before the age of 65?Would you describe the amount of weekly exercise that you get as low (less than 30 minutes of physical activity on most days)? NoYesHas a blood test in recent years shown that you have high cholesterol? NoYesHas a blood test in recent years shown that your LDL is too high? NoYesHas a blood test in recent years shown that your HDL is too low? NoYesHas a blood test in recent years shown that you have high triglycerides? NoYesIs your blood pressure greater than 140/90 or higher? NoYesWhat is your blood pressure? Diastolic Systolic Does your diet consist of high-fat foods? NoYesDo you ever experience rapid fatigue, shortness of breath, or light-headedness from modest physical exertion, such as walking or climbing stairs? NoYesIn recent years, have you fainted? NoYesHave you ever experienced symptoms of angina (pain, heaviness, or discomfort in your chest – or arm or jaw pain, or pain around the shoulder blades), especially with exertion? NoYesIf you previously smoked, has it been less than five years since you quit? NoYesHave you gone for years without regular medical check-ups? [radio years-w/o-checkup default:1 "No" "Yes"]Do you have diabetes? NoYesHave you ever had a stroke? NoYesHave you ever had symptoms of a “temporary” or “mini” stroke (temporary weakness in an arm or leg, or difficulty speaking that is otherwise unexplained)? NoYesWould describe the stress levels in your life as high? NoYesAveraged, do you have the equivalent of more than one drink of alcohol per day?Have you been previously tested for clonal hematopoiesis? NoYesIf answered yes, was it positive? NoYesWhat are your Test Values:Hemoglobin? g/dlHematocrit? %Red blood cell count? mcLWhite cell count? mcLPlatelet count? mcLLymph percentage? %Mono percentage? %Granulocytes percentage? %What is your cholesterol? mg/dLWhat is your LDL? mg/dLWhat is your HDL? mg/dLWhat is your Triglycerides? mg/dLHow tall are you? inchesDate of Birth? Your weight? pounds What medication are you taking?