Free Lifestyle Questionnaire

Please fill out the form with your information below.
Name
Please enter your full name as it appears on official documents.
Age
Gender
Male
Female
Occupation
Activity Level
Select your typical daily activity level.
Sedentary
Lightly Active
Moderately Active
Very Active
Super Active
Dietary Preferences
Please select any dietary preferences you follow.
Vegetarian
Vegan
Pescatarian
Keto
None
Exercise Routine
How often do you engage in physical exercise weekly?
None
1-2 times
3-4 times
5 or more times
Smoking Habits
Do you currently smoke?
Yes
No
Alcohol Consumption
How often do you consume alcohol?
Daily
Weekly
Monthly
Rarely
Never
Stress Management Techniques
How do you typically manage stress?
Exercise
Meditation
Reading
Socializing
Other
Sleep Patterns
How would you describe your sleep pattern?
Consistent
Inconsistent
Meal Frequency
How often do you eat meals daily?
1-2 times
3 times
4 or more times
Personal Health Goals
What are your main health goals currently?
Additional Information
Provide any additional comments, notes, or concerns.
Thank you for your submission!
We appreciate you taking the time to submit.
Create free forms at Template.net
- 100% Customizable, free editor
- Access 1 Million+ Templates, photo’s & graphics
- Download or share as a template
- Click and replace photos, graphics, text, backgrounds
- Resize, crop, AI write & more
- Access advanced editor
This Lifestyle Questionnaire Template from Template.net is a fully editable and customizable tool designed to assess habits, preferences, and daily routines. With the AI Editor Tool, easily modify questions to fit your needs. Ideal for wellness programs, research, and personal development. Start customizing your questionnaire today.