Health Assessment Questionnaire

Personal Information

Hello, thank you for taking the time to complete this Health Assessment Questionnaire. The purpose of this questionnaire is to gather information about your health status so that we can better understand your current health condition and provide appropriate recommendations for your well-being. The survey should take a few minutes to complete, and all responses will be kept confidential.

Please answer all questions to the best of your ability. If you do not know the answer to a question, please choose the response that is most appropriate for you.

1. What is your age?


2. What is your gender?


3. What is your height in feet and inches?


4. What is your weight in pounds?