Your health You will only see the questions relevant to the area you chose.
Before continuing: the questions below may include health information. It is used only to help assess whether a research study may be a fit and to let a research professional contact you. Your answers are not saved until you submit.
Have you been told you have any of these conditions?
Have you ever had any of these heart or circulation conditions?
Have you ever been diagnosed with cancer, other than skin cancer?
- Select - No Yes, more than 5 years ago Yes, within the past 5 years Yes, currently in treatment
Do you smoke?
- Select - Never smoked Past smoker Current smoker
Are you pregnant, breastfeeding, or planning a pregnancy?
Have you had any big change in your weight in the last 3 months?
In the past, have you used any of these to manage weight?
When did you have weight-loss surgery?
- Select - Less than 1 year ago 1 to 2 years ago More than 2 years ago
Have you been told you have sleep apnea?
Have you been diagnosed with diabetes?
- Select - Yes No Not sure
What type of diabetes do you have?
- Select - Type 1 diabetes Type 2 diabetes Gestational (during pregnancy) Prediabetes / high blood sugar Unsure
When were you first diagnosed?
- Select - Less than 6 months ago Less than 1 year ago 1 to 4 years ago More than 4 years ago
Do you take medication for your diabetes?
- Select - Yes No Not sure
Are they taken by mouth, by injection, or both?
Which oral diabetes medications?
Which injectable diabetes medications?
Have you used insulin in the last 12 months?
Have you had any diabetes-related complications?
Have you had episodes of low blood sugar?
Have you ever had pancreatitis (a painful swelling of the pancreas)?
Which joint or arthritis condition(s) do you have?
Which joints are affected?
How long have you had joint symptoms?
- Select - Less than 3 months 3 to 6 months 7 to 12 months More than 1 year
How much does the pain affect walking, stairs, sleep, work or daily life?
- Select - Not at all A little Moderately A lot
How many days a week do you take something for the pain?
- Select - I do not take medication for it 1 to 2 days 3 days 4 to 7 days
Do your current pain medications help enough?
Do you use cannabis or opioids for pain?
Have you had joint injections or arthroscopy recently?
Have you had a joint replacement?
Has your doctor discussed a future joint replacement?
- Select - Yes, a date is scheduled Yes, likely in 6-12 months Yes, at a later date No Not sure
Do you use a cane, walker or other walking aid?
Do you also have back pain?
Where is your back pain?
- Select - Upper back Middle back Lower back I do not have back pain
How long have you had low back pain?
- Select - Less than 3 months 3 to 6 months 7 to 12 months More than 1 year
How many treatments have you tried for back pain?
- Select - 0 1 2 3 4 5 or more
Does your back pain travel down your leg below the knee?
Have you ever had back surgery?
Which best describes your heart-health concern?
- Select - High blood pressure High cholesterol or triglycerides Heart disease or heart failure Not sure
Have you been told you have high blood pressure?
Are you taking blood pressure medication?
- Select - No Yes, unchanged in the past month Yes, changed in the past month
Are you on more than two blood pressure medicines?
- Select - MAOIs (for depression) Weight-loss medication Erectile-dysfunction medication None of these Not sure
Do you take prescription anti-inflammatories or daily low-dose Aspirin?
Any major surgery planned in the next year?
Have you been told you have high triglycerides?
Have you been told you have high cholesterol?
Are you taking a statin or other cholesterol medication?
Have you ever reacted badly to a cholesterol medication?
Have you been told you have heart failure?
Have you had, or are you waiting for, a heart transplant?
Do everyday activities like walking or climbing stairs leave you short of breath or very tired?
- Select - No A little A lot I am short of breath even at rest
Have you stayed overnight in a hospital because of heart failure in the past year?
About when was your most recent heart or circulation event?
- Select - Less than 6 months ago 6 to 12 months ago 1 to 5 years ago More than 5 years ago Not applicable
Do you take a blood thinner for atrial fibrillation?
Have you been told you have peripheral artery disease (poor circulation in the legs)?
Do you get leg pain or cramping when walking that eases with rest?
Have you had any procedures for circulation?
Have you been told you have chronic kidney disease?
Have you been told you have anemia?
Have you been told you have protein or albumin in your urine?
Are you on dialysis, or about to start?
Have you had or are you planning a kidney transplant?
Was it completed, or is it planned?
Approximate timing
- Select - Less than 1 year 1 to 3 years More than 3 years Not sure
Any recent hospital stays?
Which breathing or lung condition(s) have you been told you have?
When were you diagnosed?
- Select - Less than 6 months ago Less than 1 year ago 1 to 5 years ago More than 5 years ago Not sure
Any of these other lung conditions?
Which breathing medications do you use?
Any flare-ups needing a doctor or ER visit in the past year?
- Select - Yes No Not sure
Did you need oral steroids or antibiotics for a flare-up?
Do you use oxygen at home?
When were you told you have pulmonary fibrosis?
- Select - Less than 1 year ago 1 to 3 years ago 3 to 5 years ago More than 5 years ago
- Select - Taking now Took in the past Never
Have you been told you have liver or kidney disease?
If you quit, how long ago?
- Select - Less than 1 year 1 to 5 years More than 5 years
Have you been diagnosed with migraine?
- Select - Yes No
Has a doctor assessed your headaches?
When did your migraines begin?
- Select - Less than 6 months ago Less than 1 year ago 1 to 5 years ago More than 5 years ago Not sure
Do you get aura (warning signs) with your migraines?
Are your migraines linked to your menstrual cycle?
Which as-needed (acute) medications do you use?
Which preventive medications have you used?
Any ER visits for severe attacks?
Have you been diagnosed with cluster headaches?
- Select - Yes No
Are you in a cluster period right now?
How long do your cluster periods usually last?
- Select - 1 week or less 2 to 3 weeks 1 to 2 months 3 to 6 months More than 6 months
How long are you usually pain free between cluster periods?
- Select - Less than 1 month 1 month or more
Have you been diagnosed with IBS (irritable bowel syndrome)?
- Select - Yes No Not sure
Which best describes it?
- Select - Mostly constipation Mostly diarrhea Mixed Unsure
How long and how often do you have symptoms?
- Select - Recent, occasional Months, weekly Long-standing, most days
How severe is your abdominal pain?
- Select - None Mild Moderate Severe
Which best describes your concern?
- Select - Menopause / hot flashes Endometriosis Bladder or urinary Other
Are you going through menopause with hot flashes?
Have you been menopausal for at least 12 months?
How many hot flashes a day, on average?
- Select - About 3 About 5 7 or more
Have you been told you have endometriosis?
Have you had surgery for endometriosis?
How would you rate your pelvic pain?
- Select - None Mild Moderate Severe Very severe
Do you have urine leakage (with activity, urgency, or trouble getting to the toilet)?
Do you leak urine when you cough, sneeze, laugh, lift, or exercise?
Do you leak urine because you cannot get to a toilet in time?
Do you get up more than once a night to urinate?
How long have you had these bladder symptoms?
- Select - Less than 6 months 6 months to 1 year 1 to 5 years More than 5 years
Do you or someone you care for have memory or thinking problems?
- Select - Yes, diagnosed with Alzheimer's Concerned, but not diagnosed No
When did the memory problems start?
- Select - Less than 3 months ago 3 to 6 months ago 7 to 12 months ago 1 to 2 years ago 2 to 5 years ago More than 5 years ago
When was Alzheimer's diagnosed?
- Select - Less than 3 months ago 3 to 6 months ago 7 to 12 months ago 1 to 2 years ago 2 to 5 years ago More than 5 years ago
Any of these brain or nervous-system conditions?
Do you live in a long-term care facility?
- Select - No Yes
Is there a family member or friend who could come to study visits with the person?
You are not alone. If you are in crisis, call or text 9-8-8 (Suicide Crisis Helpline). If you are in immediate danger, call 911.
Have you been diagnosed with depression?
- Select - Yes No Not sure
Are you currently receiving treatment?
Are you taking any of these?
How much do symptoms affect your daily life?
- Select - Not at all A little Moderately A lot
Have you been told you have Grave's disease or an overactive thyroid?
When were you diagnosed?
- Select - Less than 6 months ago Less than 1 year ago 1 to 5 years ago More than 5 years ago Not sure
Any eye symptoms (bulging or double vision)?
Have you been diagnosed with a skin condition by a professional?
- Select - Yes No
Is your eczema active, and when were you diagnosed?
- Select - Active now, diagnosed recently Active now, long-standing Comes and goes No longer have symptoms
Are you using a prescription treatment for it now?
Which prevention or vaccine area interests you?
- Select - HPV RSV Influenza (flu) Pneumococcal COVID-19 Shingles Other
How would you describe your general health?
- Select - Excellent Good Fair Poor
Any current infection or recent illness?
Are you available for follow-up visits?
What are you interested in?
Are you interested in studies about...?
- Select - Weight Diabetes Pain or joints Heart Circulation Kidney Breathing Digestion Headaches Memory Mental health Thyroid Women's health Skin Vaccines General health
Do you currently have a diagnosed medical condition?
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