1. Are you currently a smoker?
   Yes    No
2. Is your diet filled with high cholesterol and fatty foods?
   Yes    No
3. Are you unable to meet the 20 to 30 minutes of recommended exercise three times a week as suggested by the U.S. Surgeon General?
   Yes    No
4. Are you in frequent contact with people who are ill?
   Yes    No
5. Do you work in an indoor environment that keeps you in close proximity to other people?
   Yes    No
6. Are you "stressed out," meaning that you frequently feel overwhelmed at work or at home, or do you often put in long hours at work?
   Yes    No
7. Do you forget to wash your hands with warm, soapy water after touching your eyes, nose and mouth?
   Yes    No
8. Do you consume more than a few alcoholic drinks on most days?
   Yes    No
9. Do you use illegal drugs?
   Yes    No
10. Do you have a chronic illness affecting the heart and lungs?
    Yes    No
11. Is your immune system considered compromised due to a disease or medication that you are taking?
    Yes    No

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