Lifestyle Assessment Long Form 2026

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The document is a comprehensive Lifestyle Assessment Long Form created in collaboration with Loma Linda University. It includes various sections for evaluating an individual's overall health, lifestyle habits, and areas for improvement, such as sleep, nutrition, exercise, mental health, and substance use. The assessment aims to identify personal health goals and motivations while providing a structured format for individuals to reflect on their current health status and lifestyle choices.
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  1. Click ‘Get Form’ to open the Lifestyle Assessment Long Form in the editor.
  2. Begin by circling your current overall level of health on a scale from 0 (very poor) to 10 (excellent). This provides a quick snapshot of your health status.
  3. Rank the top three areas you wish to improve, assigning numbers 1 through 3. Consider aspects like sleep, nutrition, and mental health for a comprehensive assessment.
  4. For each of your top three ranked areas, indicate how important it is for you to make changes and your confidence in making those changes using the provided scales.
  5. Proceed through each section, including sleep patterns, nutrition habits, and exercise routines. Answer all questions honestly based on your recent experiences.
  6. Utilize checkboxes for multiple-choice questions regarding dietary habits and lifestyle factors. This will help clarify your preferences and challenges.
  7. Finally, review all entries for accuracy before saving or submitting the form. Our platform allows you to easily edit any section if needed.

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Optimal nutrition is just one of the six pillars of lifestyle medicine. To fully harness the power of FAM and achieve the best possible outcomes, it should be integrated with the other five pillars: physical activity, restorative sleep, stress management, positive social connections, and avoidance of risky substances.
It is defined by the British Society for Lifestyle Medicine (BSLM) as an evidence-based discipline, which supports patients to prevent, manage and reverse certain chronic conditions, using supported behaviour changes skills and techniques to create, and sustain lifestyle changes.
The lifestyle questionnaire is there to help our doctors understand whether there are any lifestyle factors which could be influencing your test results. They can also advise you on any changes that you can make to help you lower any health risks that you may have.
Applying the six pillars of lifestyle medicinea whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connectionsalso provides effective prevention for these conditions.
The HLBES is a 15-item, self-report Likert-type scale developed to measure healthy lifestyle behaviors related to physical activity, diet, and mental health. The answers range from 1 (strongly disagree) to 5 (strongly agree), and the total possible score can vary from 15 to 75.

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The Six Pillars of Lifestyle Medicine Whole Food, Plant-Based Nutrition. Physical Activity. Stress Management. Avoidance of Risky Substances. Restorative Sleep. Social Connection.
The above-mentioned article defines lifestyle drugs as medicines that treat conditions associated with lifestyle; examples include drugs to treat weight loss, smoking, impotence, baldness and the effects of aging, as well as medications that improve mental agility.

Related links

WEIGHT AND LIFESTYLE INVENTORY (WALI)

The Weight and Lifestyle Inventory (WALI) is designed to obtain information about your weight and dieting histories, your eating and exercise habits,

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Healthy Lifestyle Questionnaire - DHHS - Nebraska.gov

Filling out this form will help Every Woman Matters (EWM) and the Nebraska Colon Cancer Screening Program (NCP) determine what services are best for you. Even

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