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Health Assessment


Please, complete this health assessment. Notice that your answers and your goals in My Health To Do List will not be saved. You can print the Health Assessment and the My Health To Do List.


1. Do you go to your health care provider at least once a year for a check up?
          

2. Do you go to your dentist at least every six months to get your teeth cleaned?
          

3. Do you eat fast food at least 3 times a week?
          

4. Do you get at least 30 minutes of moderate physical activity every day?
          

5. Have you ever been diagnosed with a sexually transmitted infection?
          

6. Do you have a written reproductive life plan?
          

7. Do you take steps to handle your stress in a positive way?
          

8. Do you smoke, or drink any alcohol?
          

9. Do you consider yourself to be a happy person
          

10. Do you have $200 or more in credit card debt?
          

11. Do you know your Sickle Cell Status?
          

12. Have you been immunized against Human Papilloma Virus (HPV)?
          

13. Do you or anyone in your immediate family have Diabetes, or High Blood Pressure?
          

14. Do you consider yourself to be underweight or overweight?
          

15. Have you ever been hit by a significant other?
          

16. Do you get at least 8 hours of sleep each night?
          

17. Do you take a multivitamin with at least 400 micrograms of folic acid every day
          

18. Have you ever had a pregnancy scare?
          

19. Do you do a monthly self breast exam?
          

20. Do you consider yourself to be in excellent health?
          




Content Last Modified: 3/7/2011 11:16:00 AM
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