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Your Insurance Needs
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(To take the Check-Up online, you will need Internet Explorer or Netscape versions 4.0 or greater.
All calculations are restricted to your computer. No information is sent over the Internet.)

1. Health Indicators

a. Which of the following best describes your current health compared to other people your age?

Excellent (0): Very Good (0):  Good (1): Satisfactory (1): Fair (2): Poor (2):

b. When was the last time you had a medical check-up or screening to help prevent problems from developing (e.g., mammography, pap smear, prostate examination)?

Within last year (0): Within last 2 years (1): Not within last 2 years (2):

c. How often has your doctor treated you for illness this past year?

Did not receive treatment (0): Less than every three months (0): Every two or three months (1): Once a month or more (2):

d. Is your cholesterol within the healthy range?

Yes (0): Don't know (1): No (2):

e. Is your blood pressure within the healthy range?

Yes (0): Don't know (1): No (3):

f. Do you have a life threatening illness (e.g., heart disease or cancer)?

Yes (15): No (0):

Proceed to section 2 - Lifestyle Choices

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