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Wellness Assessment Form
Fillable form template for conducting a wellness or health risk assessment
Wellness Assessment Form
Name, age, gender, height, weight
Blood pressure and resting heart rate
Current exercise frequency and type
Nutrition habits (meals per day, fruits/vegetables)
Sleep hours and quality
Stress level (1-10)
Tobacco and alcohol use
Medical conditions and family history
Current medications and supplements
Health goals
Signature
Date
A structured form for Fillable form template for conducting a wellness or health risk assessment.
Form Fields
- Name, age, gender, height, weight
- Blood pressure and resting heart rate
- Current exercise frequency and type
- Nutrition habits (meals per day, fruits/vegetables)
- Sleep hours and quality
- Stress level (1-10)
- Tobacco and alcohol use
- Medical conditions and family history
- Current medications and supplements
- Health goals
- Barriers to healthy lifestyle
- Readiness to change assessment
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