Health Assessment Questionnaire Important Notice: Please note that completing this health assessment is not a means of scheduling an appointment. Only individuals with a pre-existing appointment should proceed with filling out this form. Thank you! 🙂 Personal Details: Name: (Required) Email: (Required) Age: (Required) Weight: (Required) Height: (Required) Lunch Habits: Where and how do you usually eat your lunch on weekdays? (Required) Company’s lunch restaurant Lunch restaurant outside the company Packed lunch in the lunchroom Purchased lunch in the lunchroom Packed lunch from home at your personal workplace Eat lunch at home Purchased lunch at your personal workplace Do not eat a full lunch Do not eat any lunch at all
