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Surveys
2014
March
H
Health Assessment Health Risk Assessment
Health Assessment Health Risk Assessment
Sherry Talsma Health Risk Assessment Survey
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What is your gender
Male
Female
What is your age category?
18- 25 years old
26- 31 years old
32- 39 years old
40- 47 years old
48- 55 years old
> 55 yearsold
Do you smoke or use any tobacco
Yes
No
How much do you smoke?
Less than a pack a day
1 pack a day
More than one pack a day
Do you drink alcohol?
Yes
No
How much alcohol do you drink?
Occassionally
1 drink daily
2 drinks daily
3 drinks daily
4 or more drinks daily
Do you regularly excercise?
Yes
No
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