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Wellness Evaluation Questionnaire - Excel Health - excel-health 2026

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The document is a Wellness Evaluation Questionnaire designed for patients at Excel Health. It collects comprehensive personal, medical, and lifestyle information to create a medical record while ensuring confidentiality under HIPAA standards. The questionnaire includes sections on medical history, current medications, family history, environmental factors, lifestyle habits, and patient agreements regarding treatment and insurance responsibilities.

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Click ‘Get Form’ to open the Wellness Evaluation Questionnaire in the editor.
Begin by entering your personal information, including your name, email, and address. Ensure all details are accurate for effective communication.
Proceed to the Medical History section. Check any conditions you currently have or have had in the past five years. This helps provide a comprehensive view of your health.
Fill out the Current Medications section by listing all medications you take, including dosage and frequency. This is crucial for your healthcare provider's understanding.
Complete the Family History section by checking relevant conditions that may affect your health. This information is vital for risk assessment.
For men and women, provide specific health details as requested in their respective sections, ensuring to include any relevant medical history.
Review all entries for accuracy before submitting. Use our platform’s features to save or share your completed questionnaire securely.

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2014	4.8 Satisfied (63 Votes)

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What is done during a wellness check?

A physical exam checks your overall health. Your healthcare provider will evaluate the basic function of your organs, address any concerns, update your vaccinations and help you get healthy or maintain good health. Get a physical exam each year. It takes about 30 minutes to complete.

What are the 8 areas of wellness assessment?

Your physical examination includes a check on your blood pressure, body temperature, respiratory rate, height, and body weight. Your nerves, muscle strength, reflexes, and balance are observed. Your provider also checks for visible physical changes such as lumps.

What is a wellness assessment?

A good way to start is by evaluating your current state and establishing systems to guide you towards a fuller sense of well-being. The Wellness Wheel describes the integration of 7 important dimensions of wellness: emotional, environmental, intellectual, occupational, physical, social and spiritual.

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