Health Risk Assessment Form - Wellness Screening Template
Health Risk Assessment Form - Wellness Screening Template
A health risk assessment form for employers and wellness programs to evaluate lifestyle habits, chronic disease risk factors, and overall employee health status.
Full Name *
Your answer
Date of Birth *
Your answer
Gender
Male
Female
Non-binary
Prefer not to say
Height *
Your answer
Weight *
Your answer
How would you describe your current overall health?
Excellent
Very Good
Good
Fair
Poor
Have you been diagnosed with any of the following conditions?
How many days per week do you engage in at least 30 minutes of physical activity?
0 days
1-2 days
3-4 days
5 or more days
+ 14 more questions
About this template
A health risk assessment form for employers and wellness programs to evaluate lifestyle habits, chronic disease risk factors, and overall employee health status.
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