Healthy Life Health Risk Assessment

What is Your First Name?*

What is Your Last Name?*

What is Your Prefered Email?

Are you male or female?*

Male
Female

When were you born? *

What race do you mostly identify with?*

Aleutian, Alaska native, Eskimo, or American Indian
Asian
Black
White
Pacific Islander
Other
I Don't Know

Are you of Hispanic Origin?*

Yes
No

What is your home address?

The purpose of this assessment is for you to explore and learn about your health risks.

Participation will take about 15 minutes.

Your answers will be maintained as confidential.

You will receive a complete health risk assessment report you can share with your Primary Care Physician.

Your company will receive a group report, excluding any employee identifying information.

If you have any questions about this assessment you can contact your Human Resource Department or email [email protected].

Prior to your scheduled onsite appointment to collect clinical data please follow these fasting guidelines:

Nothing to eat and no smoking for 8 hours.
Drink ONLY water, black coffee, or plain tea.
Please drink plenty of water during the entire fasting time.

Do you want to Create An Account ? You can save your results, track your progress over time, and get more customized results. Don't worry, we'll save your progress.

Let's Start!

We need some basic information about you so we can ask the right questions:

About Us

Service Documentation

Health Risk Assessment