Health evaluation form
A health evaluation form is a document that is used by healthcare providers to assess the health of an individual. The form includes questions about the individual's medical history, family medical history, current health status, and lifestyle.
2 minutes to complete
Eligibility
It is usually completed by a doctor or nurse, but can also be completed by other health professionals such as a physiotherapist or occupational therapist.
Questions for Health evaluation form
Questions
1.
How often do you visit a doctor or medical professional?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
2.
How often do you feel ill or experience symptoms?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
3.
How often do you take medication?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
4.
How often do you feel pain?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
5.
How often do you feel anxious or stressed?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
6.
How often do you feel tired or fatigued?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
7.
How often do you have trouble sleeping?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
8.
How often do you have difficulty concentrating?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
9.
How often do you have difficulty remembering things?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
10.
How often do you have mood swings or feel irritable?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
11.
How often do you feel depressed or sad?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
12.
How often do you feel happy or content?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
13.
How often do you eat a nutritious meal?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
14.
How often do you get enough exercise?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
15.
How often do you take care of your personal hygiene?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
16.
How often do you feel like you are in control of your life?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
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Here are some FAQs and additional information
on Health evaluation form
What is a health evaluation?
A health evaluation is a physical examination performed by a healthcare professional to assess the health of an individual. It may include a review of the individual's medical history, a physical examination, and laboratory tests.
Who needs a health evaluation?
Anyone who is considering beginning a new fitness program or making significant changes to their current exercise routine should consider having a health evaluation. This is especially important for people with chronic health conditions or risk factors for heart disease.
How often should I have a health evaluation?
The frequency of health evaluations depends on the individual's age, health history, and current level of physical activity. People who are starting a new fitness program or making significant changes to their current routine should have a health evaluation every six to 12 months. People with chronic health conditions or risk factors for heart disease should have a health evaluation every three to six months.
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