Assessment

Section 1: Core Demographics

Full Name *

Email Address *

Phone Number *

Date of Birth *

Biological Sex *

Height

Weight

Section 2: Lifestyle & Habits

Sleep

Average hours per night

Quality of sleep (1-10)

Do you wake refreshed?

YesNo

Use of sleep aids or supplements

Movement

Exercise frequency

Sedentary time per day (hours)

Nutrition

Primary diet pattern

Daily protein intake

Water intake (oz/day)

Alcohol consumption

Caffeine intake

Recovery & Stress

Perceived stress level (1-10)

Regular relaxation practice?

YesNo

Energy level throughout day

Section 3: Biological Markers & Testing

Have you completed or are you interested in:

Full Blood Biomarker PanelMethylation Panel (MTHFR, MTR, MTRR, AHCY, COMT)TruAge Epigenetic Age TestHormone Profile (E2, T, DHEA, Cortisol)Micronutrient TestingGut Microbiome Analysis

Most recent lab testing date

Section 4: Supplementation & Therapeutics

Section 5: Mental Health & Cognitive Function

Mood stability (1-10)

Focus / concentration (1-10)

Memory concerns?

YesNo

Anxiety or depression history

YesNo

Current practices for mindset growth (Select all that apply)

JournalingCoachingMeditationOther

Section 6: Longevity Self-Rating

Rate your perceived level of performance in each domain:

Domain	Current Level (1-10)	Desired Level (1-10)
Sleep Quality
Nutrition
Exercise & Mobility
Stress Management
Energy & Vitality
Cognitive Function
Emotional Resilience
Purpose & Fulfillment

Category	Current Use	Interested In
NMN/NAD+ Boosters
Spermidine
Astaxanthin
CoQ10
Vitamin D3 + K2
Omega-3
Peptide Bioregulators
Stem Cell / Exosome Therapy

Arise Elite Longevity Assessment

Section 1: Core Demographics

Section 2: Lifestyle & Habits

Sleep

Movement

Nutrition

Recovery & Stress

Section 3: Biological Markers & Testing

Section 4: Supplementation & Therapeutics

Section 5: Mental Health & Cognitive Function

Section 6: Longevity Self-Rating

Section 7: Personalized Longevity Focus