How much money does he make a year?
$0 to $5,000 * 1 point
$5,000 to $15,000 *2 points
$ 15,000 to $25,000 * 3 points
$25,000 to $32,000 * 4 points
$32,000 to $36,000 * 5 points
$36000, to $42,000 * 6 points
$42,000 to $50,000 * 7 points
$50,000 to $70,000 * 8 points
$70,000 to $90.000 * 9 points
$Over $90,000 a year * 10 points
Has he had?
One Heart Attack or More * 1 point
Full dentures * 2 points
More then five dental crowns * 3 points
Smoke a pack of cigarettes a day * 4 points
Back Problems * 5 points
Migraines * 6 points
Allergies * 7 points
Occasional Muscle Strains * 8 points
No cavities * 9 points
No Health Problems whatsoever * 10 points
Has he ever been diagnosed with any of the following?
Schizophrenia * 1 point
Manic Depression * 2 points
Paranoia * 3 points
Personality * Disorder4 points
Anger Management * 5 points
Attention Deficit Disorder * 6 points
Obsessive Compulsive * 7 points
Depression * 8 points
Anxiety * 9 points
No disorders * 10 points
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