KLOTHO Testing Research Registry Clinical Study

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* 1. I understand that klotho testing is only available for research use only at this time and consent to participate in this research as signified by my eSignature at the bottom of this onboarding and outboarding research information form

Yes

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* 2. The research purpose(s) of my klotho testing are (choose as many that apply)....

For information purposes to understand where I or my patients stand related to their peer age group

To help identify of lifestyle changes improve my klotho levels

To identify if a specific exercise routine increases my klotho levels better than another

To identify if a specific diet plan increases my klotho levels better than another

To identify if a specific set of commercially available supplements increase my klotho levels better than other choices or no supplements

To identify if breathing exercises increase my klotho levels

To identify if specific sleep patterns increase my klotho levels over others

To identify if gut health management increases my klotho levels

To identify if meditation and/or yoga increases my circulating klotho levels

To identify if improvement to my joint health increases my klotho levels

To identify if specific changes in my sexual activity increase my klotho levels

To identify if my weight loss program increases my klotho levels

As part of a research study at a academic institution

Other

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* 3. I have these pre-existing conditions...

Pregnant

Cancer

Heart disease

Cardiovascular disease

Auto-Immune disease

Depression

Anxiety

Attention Deficit Disorder

Liver, kidney or pancreas disease

Lung disease

Skin disease

Vision loss

Hearing loss

Hair loss

Irregular more than normal skin spots or wrinkles

Skin rashes

Sexual health decline

Joint pain

Difficulty breathing

Sleep apnea

Frequent headaches

Migraine headaches

Frequent nausea

Essential tremor

A-Fig or other irregular heartbeats

High or low blood pressure

Blood clots

Arterial plaque

Memory loss

Cognitive function decline

Irritable bowel syndrome

Bladder dysfunction

Swollen prostrate

Snoring

Slow healing wounds

Ulcers

Blood sugar spikes

Dizziness

Add more details

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* 4. I know my current klotho level and it is...

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* 5. I am currently doing these things to help improve my health and rise my klotho levels (choose any and all that apply)...

Hyperbaric oxygen sessions

LED light therapy sessions

PEMF therapy sessions

EMS enhanced exercise sessions

Yoga

Meditation

Nature walks

Swimming or surfing

Weight lifting

Jogging

Marathons

Sleep management

Stress management

Massages

Sauna sessions

Steam room sessions

Electromagnetic therapy sessions

Brain mood stimulation

Joint health therapies

Sexual health optimization

Strict klotho favoring diet

Supplements

Muscle toning devices

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* 6. Name

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* 7. Address

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* 8. Email

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* 9. Date

Date / Time

Date

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* 10. eSignature

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* 11. Baseline Klotho Level

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* 12. Klotho Level @ 4 weeks

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* 13. Klotho Level @ 8 weeks

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* 14. Klotho Level @ 12 weeks (3 months)

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* 15. Klotho Level @ 6 months

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* 16. Klotho Level @ 1 year

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* 17. Klotho Level @ Later Time Points (write in time point)

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* 18. I understand this research use only survey may not be fully HIPAA compliant and agree to the use of my data without this strict confidentiality

Yes

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* 19. You can use my data but do not use my personal name in reports

Do not use my personal name in any external public research reports

You may use my name as needed

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* 20. I believe klotho testing has helped guide me to a healthier lifestyle

Yes

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* 21. Listing of Reference Age Peer Group Klotho Levels - Where am I BEFORE Lifestyle Changes

ALL Mean Men 728.3 pg/ml

All Mean Women 874 pg/ml

18 to 34.9 years Men 932.60 pg/ml

18 to 34.9 years Women 975.9 pg/ml

35 to 54.9 years Men 733.90 pg/ml

35 to 54.9 years Women 851.50 pg/ml

55 to 85 years Men 567.9 pg/ml

55 to 85 years Women 655.5 pg/ml

Any further explanation

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* 22. Listing of Reference Age Peer Group Klotho Levels - Where am I AFTER Lifestyle Changes

ALL Mean Men 728.3 pg/ml

All Mean Women 874 pg/ml

18 to 34.9 years Men 932.60 pg/ml

18 to 34.9 years Women 975.9 pg/ml

35 to 54.9 years Men 733.90 pg/ml

35 to 54.9 years Women 851.50 pg/ml

55 to 85 years Men 567.9 pg/ml

55 to 85 years Women 655.5 pg/ml

Any further explanation

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* 23. How does my baseline klotho level compare with my peer age group BEFORE lifestyle changes?

Top 10%

2nd tier top 20%

3rd tier top 30%

4th tier top 40%

5th tier top 50%

6th tier bottom 40%

7th tier bottom 30%

8th tier bottom 20%

9th tier bottom 10%

10th tier bottom 1%

Other (please specify)

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* 24. How does my POST lifestyle changes Klotho compare with my peer age group?

Top tier 10%

Top tier 20%

Top tier 30%

Top tier 40%

Top tier 50%

Bottom tier 40%

Bottom tier 30%

Bottom tier 20%

Bottom tier 10%

Bottom tier 1%

Other

Other (please specify)

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* 25. What was my percentage gain or decline in klotho in test period?

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* 26. I sleep this many hours a night on average...

5 hours

6 hours

6.5 hours

7 hours

7.5 hours

8 hours

8.5 hours

9 hours

9.5 hours

10 hours or more

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* 27. I exercise this many days a week....

None

1 day

2 days

3 days

4 days

5 days

6 days

7 days

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* 28. My exercises...

Walking

Jogging

Sprints

Heavy Weight Lifting

Moderate Weight Lifting

Light Weight Lifting

Treadmill

Pilates

Yoga

Boxing bag

Jump Rope

Stair master

Weight Circuit

Push Ups

Pull Ups

Leg Presses

Swimming

Surfing

Skiing

Roller Blading

Soccer

Hockey

Flag Football

Baseball

Softball

Volleyball

Paddleboarding

Bicycle Riding

Horse Riding

Golf

Tennis

Pickle Ball

Racquet Ball

Martial Arts

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* 29. I am taking these medications

Pain medication

Heart medication

Cardiovascular medication

Kidney health medication

Breathing medication

Sleeping medication

Anxiety medication

Blood pressure medication

Focus medication

Diabetic insulin

Infection control medication

Vision medication

Hearting medication

Skin rash treatment medication

Sexual health medication

Gut health medication or pre or pro biotics

Inflammation medication

Auto-immune disease medication

Weight loss medication or supplements

Essential tremor medication

A-Fib medication

Please list brand names of medications taken

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* 30. After increasing my klotho levels I have noticed the following...

Increased energy

Better cognition

Better memory

Better mood

Less headaches

Thicker hair

More youthful looking skin

Better vision

Better hearing

More healthy blood pressure

Better sleep

Healthier sex life

Stronger grip strength

Muscles are more toned

Bladder function is better

Gut health is better

Joint pain reduction

Longer endurance

Faster recovery time

Better work productivity

Lower blood sugar levels and less spikes

Less additive cravings

Less skin damage when in sun

Better sports skills

More joy and happiness