MUSC 2026 Health Risk Assessment
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About you
1. Full Name
2. Email address (We'll email you the results to discuss with your provider)
3. Your Age (years)
4. Height
5. Weight
Health Risk Assessment questions
1. In the past 30 days, how would you rate your overall physical health?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
2. In the past 30 days, how would you rate your overall mental/emotional health?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
3. How often do you engage in moderate to vigorous physical activity?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
4. How would you rate the quality of your sleep on a typical night?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
5. How often do you feel stressed during a typical week?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
6. How would you rate your current energy level?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
7. How often do you eat fruits and vegetables?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
8. How often do you consume sugary drinks or snacks?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
9. How would you rate your current level of physical pain or discomfort?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
10. How often do you feel anxious or worried?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
11. How would you rate your ability to manage daily stress?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
12. How often do you feel socially connected to others?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
13. How would you rate your work-life balance?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
14. How often do you consume alcoholic beverages?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
15. Do you currently use any tobacco products?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
16. How would you rate your current blood pressure control (if known)?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
17. How would you rate your current blood sugar control (if known)?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
18. How often do you attend preventive health checkups?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
19. How would you rate your current body weight satisfaction?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
20. How often do you experience headaches or migraines?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
21. How would you rate your overall dietary habits?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
22. How often do you feel rested upon waking?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
23. How would you rate your current level of motivation for healthy habits?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
24. How often do you use safety equipment (seatbelts, helmets, etc.)?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
25. How would you rate your overall satisfaction with your current health?
Very Poor / Never
Poor / Rarely
Fair / Sometimes
Good / Often
Excellent / Always
Submit