Health and Wellness Questionnaire

A health and wellness questionnaire is used to assess an individual’s level of fitness and the physical condition.  This type of questionnaire helps a person to find out the area of health where special consideration or improvement is needed. It is also necessary to fill the health and wellness questionnaire if an individual is planning to start weight training or strenuous physical activity for the first time.

The questionnaire also determines whether it is necessary to visit a physician before starting the training.

Health and Wellness Questionnaire Sample

All the information provided by you is strictly confidential

Name: ________________

Age: ___________________

Why according to you is healthy body important?


What does health and wellness means to you?


Have you been treated for any kind of heart disease in the past?


Is there a chest pain whenever you are involved in a physical activity?


Are you under any medical supervision?


Is there any other activity that results in chest pain?


Have you ever fainted or felt nausea tic?


Do you have high blood pressure problem?


Is it difficult for you to breathe whenever you exercise?


Are you aware of any medication that you are taking?


Are you currently pregnant?


Did you give birth to a child in last two months?


Did you have a surgery recently?


Do you have any physical disability or any condition that prevents you from exercising?


Do you have a high level of cholesterol?



Category: Health Questionnaire

Comments are closed.

Copy Protected by Chetan's WP-Copyprotect.