Health Fitness Assessment Questionnaire


A health fitness assessment questionnaire is beneficial for identifying the health and fitness of an individual. It also brings out the areas that the individual needs to change in order to maintain a healthy and fit life always.

Sample Health Fitness Assessment Questionnaire

Name of the individual __________________________________

Contact Number __________________________________

Address __________________________________

Gender __________________________________

1. Are you employed in a role which is mostly deskbound?

a) Yes

b) No

2. Do you suffer from any diseases such as blood sugar, blood pressure or heart disease?

a) Yes

b) No

3. Are you under any kind of medical supervision for any of the diseases?

a) Yes

b) No

4. Do you feel nauseous or feeble after a walk or climbing stairs?

a) Yes

b) No

5. Do you have any symptoms of physical difficulty or pain after indulging in any of the physical activities?

a) Yes

b) No

6. Do you have an active lifestyle which involves healthy food and active life?

a) Yes

b) No

7. Is there a family history of diseases in your family?

a) Yes

b) No

8. Do you have any fitness goals to achieve at present?

a) Yes

b) No

9. Have you enrolled yourself for any fitness training activity in the recent times?

a) Yes

b) No

10. Do you maintain a healthy height and weight ratio always?

a) Yes I maintain a good height weight ratio

b) No I am overweight and planning to reduce weight

11. Do you take enough steps to manage stress?

a) Yes

b) No

12. Do you ensure to get sufficient sleep at night time?

a) Yes

b) No

13. Are you under any kind of medication since the past few months?

a) Yes

b) No

14. How often do you have a medical examination?

a) Once in a month

b) Once in a quarter

c) Once in every six months

d) Once in a year

Category: Health Questionnaire

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