Health Assessment Form

  • Takes just minutes to complete
  • Focuses on biometric and lifestyle questions
  • Captures data in core areas such as nutrition, physical wellbeing, stress management, family history etc.
  • Features WellnessDoc's proprietary algorithmic risk scores
  • Feedback report for members, including tips on how to improve their “risk” areas
  • Feeds into MyWellness,  and your year-over-year stats and track progress over time
  • Feeds into the WellnessDoc Connect, our lifestyle coaching sessions that our Physicians review one on one with you

Please fill this form to the best of your knowledge. This helps us give a snapshot of your current health, and we use the data to compute your health risk profile which will be emailed to you. Incorrect responses will produce incorrect reports.

Physical Activity

Tell us a bit about your typical daily physical activities. We would need this information so that we can come with an activity plan that fits your profile.

Food & Nutrition

Tell us a bit about your typical daily food intake. 

Family History
Social Habits
Tell a bit about yourself

Tell us a bit about yourself so that we can compute your BMI and activity risk score.


You have now filled out all the questions for the risk profile assessment. Please review all your answers before submission. We need a name and email to send out the completed report to. So please enter those details below as well.