Survey
The Basics
Nutrition
Exercise
Joint History
Fitness
The Basics
What year where you born?
*
Skipping may be good for your joints, but not for this test. Complete this section before moving on.
Date
Format: 2017
What's your gender?
*
Male
Female
What's your weight?
*
lbs
What's your height?
*
Feet
Height Inches
*
Inches
Nutrition
In a typical day, how many servings of fruits and vegetables do you eat?
*
1 serving of vegetables = 1 cup of broccoli
1 serving of fruit = 1 medium apple
In a typical day, how many full 8 ounce glasses of water do you drink?
*
1 glass = 8 ounces
Do you take vitamins or supplements regularly? (Check all that Apply.)
*
Daily Multivitamin
Glucosamine
Chondroitin
Omega-3 Fatty Acids
Vitamin D
Vitamin K
Vitamin C
Vitamin E
Calcium
I do not take any vitamins or supplements
Exercise
In a typical week, how many days do you exercise?
*
What's your main type of exercise?
*
Aerobics/exercise classes
Walking
Biking
StairMaster™ or elliptical
Golf
Yoga
Swimming
Hiking
Running/jogging
Weight lifting
Basketball, soccer or baseball
Other
I do not exercise
When you exercise, do you experience any joint discomfort?
*
1 (no discomfort) to 10 (extreme discomfort)
Joint History
Do you have a family history of healthy, flexible joints?
*
Yes, I have a family history of healthy, flexible joints
No, I don't have a family history of healthy, flexible joints
I don't know
Have you ever had a major injury or surgery to your joints?
*
Yes
No
Fitness
How many push-ups (either regular: from the toes, or modified: from the knees) can you complete?
*
0
1 - 10
11 - 20
more that 20
When bending at the waist to touch your toes, how far can you reach?
*
Fingers touching knees
Fingers touching shins
Fingers touching ankles
Fingers touching toes
Hands flat on floor
When you walk down a short flight of stairs, how do your joints feel?
*
1 = no pain and 10 = extreme pain.
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