PhysioAge (Age Analysis) Test

Answer the following questions about yourself:

1.
Has the elasticity, firmness and resistance of your skin reduced?
Yes
No
2.
Are you experiencing problems to remember things or dementia?
Yes
No
3.
Are you susceptible to health conditions like cold and flu that persists for a long time?
Yes
No
4.
Is your blood pressure more than normal?
Yes
No
5.
Do you have an overall decrease in energy and vigor?
Yes
No
6.
Do you experience changes in sleep patterns?
Yes
No
7.
Do you have the tendency to become fatigued or tired easily?
Yes
No
8.
Are you experiencing loss or decrease in vision and hearing?
Yes
No
9.
Are you suffering from sexual dysfunction?
Yes
No
10.
Do you have urinary problems that fall under the category of inconsistence, dribbling, or change in frequency of urinating?
Yes
No
Please answer all of the questions before continuing.

Please provide us with your contact information to email your test results.

First Name:
Last Name:
Phone:
E-mail: