Health Prevention Checklist
Review and track your key health prevention activities to stay on top of your well-being.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Have you had a general health check-up in the past year?
*
Yes
No
Which of the following preventive health activities have you completed in the last year? (Select all that apply)
Blood pressure screening
Cholesterol screening
Flu vaccination
Cancer screening (e.g., mammogram, colonoscopy)
Dental check-up
Vision test
Other
How often do you engage in physical activity (such as walking, running, or sports)?
*
Please Select
Daily
Several times a week
Once a week
Rarely
Never
Do you currently use any tobacco products?
*
No
Yes, occasionally
Yes, regularly
Please share any additional comments or concerns about your health prevention activities.
Submit Checklist
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