About this template
The Am I Healthy Quiz template provides individuals with a structured, easy-to-use self-assessment tool to review their daily habits, physical activity, nutrition, sleep patterns, and mental well-being. By collecting insights across key lifestyle domains, this form helps users identify positive routines and pinpoint areas needing improvement.
Ideal for health coaches, fitness professionals, clinics, and wellness programs, this quiz serves as an engaging starting point for client consultations or public health awareness initiatives. Doc2Form allows you to instantly transform documents or prompts like this into fully functional Google Forms, making it effortless to gather responses and kickstart wellness discussions.
With clear questions covering sleep hygiene, dietary habits, stress levels, and routine medical checkups, respondents receive a comprehensive snapshot of their current lifestyle choices. The layout is optimized for quick completion on any device, encouraging higher engagement and actionable insights.
Key features
- Evaluate key wellness pillars including sleep, diet, and activity
- Engage clients and patients with an interactive self-assessment
- Streamline health coaching intakes and wellness consultations
- Fully customizable questions tailored to your program goals
- Mobile-friendly format for quick completion on any device
Use cases
- Initial intake questionnaires for private health coaches
- Wellness challenges and corporate employee health programs
- Educational activities for nutrition and physical education courses
- Community health awareness campaigns and seminars
What this form collects
- Sleep Hours Per Night (Multiple choice)On average, how many hours of sleep do you get each night?
- Daily Fruit & Vegetable Servings (Multiple choice)How many servings of fruits and vegetables do you typically eat each day?
- Physical Activity Frequency (Multiple choice)How often do you engage in moderate to vigorous physical activity (e.g., brisk walking, running, strength training)?
- Smoking Status (Multiple choice)Select the option that best describes your tobacco or nicotine use.
- Alcohol Consumption Frequency (Multiple choice)How often do you consume alcoholic beverages?
- Stress Frequency (Multiple choice)How often do you experience high levels of stress in your daily life?
- Chronic Health Condition Status (Multiple choice)Do you currently manage any diagnosed chronic health conditions (e.g., diabetes, hypertension, asthma)?
- Regular Medical Check-up Status (Multiple choice)How often do you visit a healthcare professional for routine physical exams or check-ups?
- Overall Diet Rating (Linear scale)Rate the overall quality of your daily nutrition.
- Overall Mental Well-being Rating (Linear scale)Rate your current sense of emotional and mental well-being.
- Additional Health Comments (Paragraph)Share any other details about your health goals, habits, or concerns that you would like us to know.
FAQ
What is the purpose of this health assessment quiz?
It helps individuals review their daily lifestyle habits—such as nutrition, sleep, and exercise—to identify strengths and areas for wellness improvement.
How can I customize this Google Form template?
Once generated in Google Forms, you can easily add, remove, or edit questions, adjust branding, and change response settings to fit your exact needs.
Who typically uses this questionnaire?
Health coaches, personal trainers, wellness clinics, and corporate wellness coordinators use it to screen participants and establish baseline health metrics.
Are the responses confidential?
Google Forms uses secure encryption for data transmission. You can also configure your form settings to collect responses anonymously if preferred.
How do I share this form with my audience?
You can share the form via a direct link, embed it on your website, or send it directly via email to your clients or participants.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.