Cholesterol Super Survey
IMPORTANT (1 of 2): Please fill this out carefully and HONESTLY. It's important we gather accurate data. Thank you!

IMPORTANT (2 of 2): You may or may not be contacted after submission. Please watch for updates at this dedicated page: https://www.cholesterolcode.com/supersurvey
Personal Information (Not Shared)
NOTE: The information collected in this section (first name, last name, email, and DOB) will be for INTERNAL USE by the Cholesterol Code team and will not be released publicly.
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Date of Birth *
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Demographics
NOTE: Everything from this section and below will be part of the shared anonymized data pool.
Age *
Your answer
Height (examples: 6'2 or 188cm) *
Your answer
Weight (examples: 170lb or 77kg) *
Your answer
Gender *
City *
Your answer
State *
Your answer
Diet
What is a ballpark of your average of your daily calories? *
Your answer
About how many grams of protein do you typically consume in a day? *
Your answer
About how many grams of fat do you typically consume in a day? *
Your answer
About how many grams of net carbs do you consume in a day? (Net carbs = total carbs - fiber) *
Your answer
List any supplements you take such as vitamins, fish oil, etc *
Your answer
List any medications you are taking *
Your answer
Exercise
In a typical week, about how many hours do you spend doing cardiovascular / aerobic exercise? *
Your answer
In a typical week, about how many hours do you spend doing HIIT (high intensity interval training) / anaerobic exercise? *
Your answer
In a typical week, about how many hours do you spend doing weight lifting / resistance training? *
Your answer
Risk and History
Is there a history of early heart disease or stroke in your family? *
If you've had a Coronary Artery Calcium (CAC) test before, what was the most recent score? (Leave blank if you've never had one.)
Your answer
Have you had your genetics tested with a service such as 23andMe? *
Most Recent Bloodwork (on this current diet)
Please fill out the details on your MOST RECENT cholesterol blood test
When was this test taken? *
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Were you water-only fasted for 12-14 hours before the cholesterol test? If not, write in how long. *
In what units are your blood measurements? (usually mg/dL in the US, mmol/L outside the US) *
Total Cholesterol:
Your answer
LDL Cholesterol (LDL-C):
Your answer
HDL Cholesterol (HDL-C):
Your answer
Triglycerides (TG):
Your answer
Last bloodwork taken BEFORE beginning your current diet
Please fill out the details on the last cholesterol blood test you took BEFORE beginning the diet you’re on now
When was this test taken? *
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DD
/
YYYY
Were you water-only fasted for 12-14 hours before the cholesterol test? If not, write in how long. *
In what units are your blood measurements? (usually mg/dL in the US, mmol/L outside the US) *
Total Cholesterol:
Your answer
LDL Cholesterol (LDL-C):
Your answer
HDL Cholesterol (HDL-C):
Your answer
Triglycerides (TG):
Your answer
General Experiment Interest
Do you have any interest of participating in studies on a wide variety of topics? And if so, may we contact you through the email you provided above?
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