Innovation in Next Generation Sequencing

Making Genomics Available and Affordable for Everyone

Wellness Research Program

Online Wellness Research Program
By checking this field you agree to participate in GTC's Online Wellness Research Program

Gender
MaleFemale

Race/Ethnicity
American Indian or Alaska Native onlyAsian OnlyNative Hawaiian or Other Pacific Islander onlyBlack or African American onlyWhite onlyHispanic or Latino2 or more races

Education

Family Income
Thousands $

Family Type

Country of Birth
USOutside US

Disability Status
Without DisabilitiesWith Disabilities

Sexual Orientation
Straight MaleStraight FemaleGay/LesbianBisexual

Marital Status

Do You Currently Smoke?
NoYesOccasionally

Do 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)?
NoYes

Has a blood test in recent years shown that you have high cholesterol?
NoYes

Has a blood test in recent years shown that your  LDL is too high?
NoYes

Has a blood test in recent years shown that your HDL is too low?
NoYes

Has a blood test in recent years shown that you have high triglycerides?
NoYes

Is your blood pressure greater than 140/90 or higher?
NoYes

What is your blood pressure?
Diastolic Systolic

Does your diet consist of high-fat foods?
NoYes

Do you ever experience rapid fatigue, shortness of breath, or light-headedness from modest physical exertion, such as walking or climbing stairs?
NoYes

In recent years, have you fainted?
NoYes

Have 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?
NoYes

If you previously smoked, has it been less than five years since you quit?
NoYes

Have you gone for years without regular medical check-ups?
[radio years-w/o-checkup default:1 "No" "Yes"]

Do you have diabetes?
NoYes

Have you ever had a stroke?
NoYes

Have you ever had symptoms of a “temporary” or “mini” stroke (temporary weakness in an arm or leg, or difficulty speaking that is otherwise unexplained)?
NoYes

Would describe the stress levels in your life as high?
NoYes

Averaged, do you have the equivalent of more than one drink of alcohol per day?

Have you been previously tested for clonal hematopoiesis?
NoYes

If answered yes, was it positive?
NoYes

What are your Test Values:

Hemoglobin?
g/dl

Hematocrit?
%

Red blood cell count?
mcL

White cell count?
mcL

Platelet count?
mcL

Lymph percentage?
%

Mono percentage?
%

Granulocytes percentage?
%

What is your cholesterol?
mg/dL

What is your LDL?
mg/dL

What is your HDL?
mg/dL

What is your Triglycerides?
mg/dL

How tall are you?
inches

Date of Birth?

Your weight?
pounds