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NPPD Care Wellness Assessment Form

Health Assessment
A Health Assessment is a personalized evaluation of your overall well-being, based on your lifestyle and medical history. It provides insights into potential health risks and offers tailored recommendations to help you improve and maintain your health.
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Overall Wellness: How satisfied are you with your overall wellness?
Physical Health | Social Relationships | Emotional Health | Career Stability | Financial Well-being | Spiritual Purpose | Other
Wellness Time: How much time do you dedicate to daily wellness activities?
What are your health goals currently? (tick all that apply)
Weight loss, Weight gain, Muscle gain, increased energy, General Health, Sports Nutrition, Skin nutrition
Exercise: How often do you exercise?
Diet: How would you rate your diet?
Sleep: How well do you sleep?
Alcohol consumption
Smoking: How often do you smoke?
Stress: How often do you feel stressed or anxious?
Emotional Resilience: How well do you cope with emotional challenges?
How would you rate the quality of your personal relationships?
Do you feel supported by friends and family?
Are you satisfied with your current career/job?
Do you feel your workplace supports your personal and professional growth?
Financial Stability: Do you feel financially stable?
Do you feel a sense of purpose or direction in life?
Mindfulness: How often do you engage in mindfulness or spiritual practices?
Home/Work Environment: How comfortable is your home/work environment?
Nature Connection: Do you feel connected to nature or spend time outdoors regularly?
Environmental Responsibility: How often do you make environmentally conscious decisions (e.g., recycling, conserving energy)?
Satisfaction: How satisfied are you with your sexual health and well-being?
Communication: Do you feel comfortable discussing sexual health with your partner or a professional?
Work-Life Balance: Do you feel your work-life balance is adequate?
Time Management: How well do you manage your time across responsibilities?
Goal Alignment: Are you satisfied with the overall alignment of your goals and actions?
DM, HTN, Thyroid dysfunction, Heart conditions

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