Health Self-Assessment Quiz Form
Take this brief self-assessment to reflect on your current health and well-being. Your responses are for your own personal reflection.
How would you rate your overall energy level in the past week?
*
1
2
3
4
5
How many days in the past week did you exercise for at least 30 minutes?
*
0 days
1-2 days
3-4 days
5-7 days
How would you describe your typical sleep quality?
*
Poor
Fair
Good
Excellent
How often do you feel stressed or anxious?
*
Rarely
Sometimes
Often
Almost always
On average, how many servings of fruits and vegetables do you eat each day?
*
0-1 servings
2-3 servings
4-5 servings
More than 5 servings
How satisfied are you with your current hydration habits?
*
Not satisfied
1
2
3
4
Very satisfied
5
1 is Not satisfied, 5 is Very satisfied
In the past week, how often did you take time to relax or unwind?
*
Rarely or never
1-2 times
3-4 times
Daily
Please indicate your agreement with the following statements:
*
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I feel physically active most days.
1
2
3
4
5
I am able to manage my stress effectively.
6
7
8
9
10
I get enough restful sleep each night.
11
12
13
14
15
Is there anything else you’d like to share about your current health habits or well-being?
Submit Quiz
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