General Health Appraisal Form

General Health Appraisal Form

Please complete this General Health Appraisal Form Template to assess and document an individual’s overall health condition.

Personal Information

Name

    Date of Birth

      Gender

        • Male

        • Female

        Phone number

          Email

            Address

              Medical History

              Current Medications

              Allergies

              Chronic Conditions

              Previous Surgeries

              Lifestyle Factors

              Dietary Habits

              Physical Activity

              Sleep Patterns

              Substance Use

              Mental and Emotional Health

              How would you rate your stress levels on a scale of 1-10?

                Have you ever been diagnosed with a mental health condition? If yes, please provide details.

                Preventive Health Practices

                Are your vaccinations up-to date?

                Occupational and Environmental Factors

                Describe your current occupation and any potential occupational hazards.

                Health Goals

                What specific health goals would you like to achieve in the next six months?

                Declaration:

                I, the undersigned, declare that the information provided in this General Health Appraisal Form is accurate to the best of my knowledge.

                Date: Date

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                Thank you for completing this form!

                If you have any questions, please contact [Company Email Address].

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