Get Health Risk Assessment Questionnaire Template

Filling out the Health Risk Assessment Questionnaire Template online is a crucial step in evaluating your health and identifying potential risks. This guide will provide you with clear and supportive instructions to help you complete the form effectively, ensuring that all relevant information is accurately captured.

Follow the steps to accurately complete the questionnaire online.

1. Press the ‘Get Form’ button to access the Health Risk Assessment Questionnaire Template and open it in your online editor.
2. Begin by entering your name in the designated field. Ensure that the spelling is correct for accurate identification.
3. Assess your general health by selecting one of the options: Excellent, Good, Fair, or Poor. Choose the option that best reflects your current health.
4. Evaluate your satisfaction with life by selecting from the provided choices: Very satisfied, Satisfied, Dissatisfied, or Very Dissatisfied.
5. Indicate the level of pain you have felt in the past 7 days by selecting from None, Some, or A lot.
6. Answer whether you usually exercise at least 30 minutes or more for 5 days a week by selecting Yes or No.
7. Determine if your diet includes at least 4 servings of fruit and vegetables and avoids high-fat foods by selecting Yes or No.
8. Describe the condition of your mouth and teeth by choosing from Excellent, Good, or Poor.
9. Indicate your alcohol consumption in a typical week by selecting one of the options provided.
10. Answer whether you ever consume 5 or more alcoholic drinks on one occasion by selecting Yes or No.
11. Confirm if you always fasten your seat belt when in a car by selecting Yes or No.
12. Provide your date of birth in the specified field for age verification.
13. State whether you know where to locate and use a first aid kit and fire extinguisher in case of an emergency by selecting Yes or No.
14. Indicate if you needed help from others to perform everyday activities in the past 7 days by selecting Yes or No.
15. Choose whether you needed assistance with household tasks in the past 7 days by selecting Yes or No.
16. Answer if you had problems staying or falling asleep in the past 7 days by selecting Yes or No.
17. Confirm any issues with constipation in the past 7 days by selecting Yes or No.
18. Indicate if you have had 2 or more falls or a fall resulting in injury in the past year by selecting the appropriate option.
19. Select whether your home has rugs in the hallway by choosing Yes or No.
20. Indicate if there are grab bars in the bathroom by selecting Yes or No.
21. Confirm if there are handrails on the stairs by selecting Yes or No.
22. Answer whether your home has good lighting by selecting Yes or No.
23. Finally, review all your answers for accuracy. Once completed, you can save your changes, download the form, print it, or share it as needed.

Complete your Health Risk Assessment Questionnaire online today for a healthier tomorrow!