BWFA Longevity Questionnaire

1
Name* This field is required.
First Name
Last Name
2
Current Age* This field is required.
3
Biological Sex* This field is required.
Please Select
Please Select
Male
Female
4
Height (in inches)* This field is required.
5
Weight (in pounds)* This field is required.
6
Do you currently smoke, or have you previously smoked any substances (e.g., tobacco, marijuana, cigars, vape)?* This field is required.
Never
Former smoker
Current smoker
7
How often do you drink alcohol?* This field is required.
Daily
Weekly
Rarely
Never
8
How many of your daily meals include fruits and/or vegetables?* This field is required.
Very little or none
About a quarter
About half
More than half
9
How often do you eat animal-based protein sources (e.g., meat, poultry, eggs, dairy, or fish)?* This field is required.
Daily
Weekly
Rarely
Never
10
How frequently do you include plant-based sources of protein—such as beans, lentils, tofu, tempeh, nuts, or seeds—as a regular part of your meals throughout the week?* This field is required.
Daily
Weekly
Rarely
Never
11
Do you typically eat until you are:* This field is required.
Full
About 80% full
Half full
12
Do you regularly eat processed foods?* This field is required.
Daily
Weekly
Rarely
Never
13
How often do you engage in physical activity that raises your heart rate?* This field is required.
Daily
Weekly
Rarely
Never
14
How much walking do you typically do in a day?* This field is required.
Less than 2,000 steps
2,000–5,000
5,000–10,000
More than 10,000
15
Do you do any kind of manual or outdoor work (gardening, home repair, chores)?* This field is required.
Yes
No
16
Do you sit for long periods (more than 8 hours a day)?* This field is required.
Yes
No
17
How many hours of sleep do you typically get per night?* This field is required.
0-5
6-7
8-10
11+
18
How would you rate your stress levels?* This field is required.
Low
Moderate
High
Chronically High
Other
19
How frequently do you practice stress-reducing activities like meditation, prayer, or hobbies?* This field is required.
Daily
Weekly
Rarely
Never
20
How often do you laugh, socialize, or engage in joyful activities?* This field is required.
Daily
Weekly
Rarely
Never
21
How would you describe your current level of financial stress?* This field is required.
Low
Moderate
High
Chronic
22
Do you feel a strong sense of purpose or reason to get up in the morning?* This field is required.
Yes
No
23
How often do you spend quality time with close friends or family?* This field is required.
Daily
Weekly
Rarely
Never
24
Do you live near or with family or have strong social support nearby?* This field is required.
Yes
No
25
Are you part of a community group, club, religious organization, or volunteer effort?* This field is required.
Yes
No
26
How often do you get medical checkups, such as physical exams, bloodwork, or screenings?* This field is required.
Yearly or more often
Every other year
Every few years
Never
27
Do you have a history of major chronic illnesses (e.g. heart disease, diabetes, cancer)?* This field is required.
Yes
No
28
Did your parents or grandparents live until age 85 or older?* This field is required.
Yes
No
29
Is your net worth $1,000,000 or more?* This field is required.
Yes
No
30
BMI
31
BMI Score
32
Total Score
33
Bonus Years
34
SSA Life Expectancy
35
Baseline Lifespan
36
Predicted Lifespan
37
Disclaimers
1. Not Medical Advice
The BWFA Blue Zone Longevity Assessment is for informational and educational purposes only. It is not intended to diagnose, treat, cure, or prevent any disease, nor should it be construed as medical advice or a substitute for professional medical evaluation or treatment. Always consult with a qualified healthcare provider regarding any medical or health-related decisions.

2. Informational Use Only
The results of this assessment are based on self-reported data and general lifestyle research. They are not predictive of actual longevity and should not be relied upon as a guarantee of future health or lifespan. Individual outcomes may vary based on factors not accounted for in this questionnaire.

3. Not a Substitute for Professional Financial Advice
While this assessment may inform elements of your financial planning, it does not replace personalized advice from a licensed financial advisor. BWFA uses your responses to help tailor financial strategies, but all decisions should be made in consultation with your financial, legal, tax, and medical advisors.

4. Privacy & Data Use
Responses submitted through this assessment may be used by BWFA to inform and enhance your financial planning experience. BWFA is committed to maintaining your privacy and safeguarding personal information in accordance with applicable data protection laws. Please refer to our privacy policy for details on how we handle and protect your data.

5. Use at Your Own Risk
Participation in the assessment is voluntary and at your own discretion. BWFA assumes no liability for any actions taken or not taken based on the results or information provided through this assessment.
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