Patient Lifestyle Survey Template

A patient lifestyle survey helps you measure the situation before the illness strikes. A pre-evaluation of the patient lifestyle choices is done by healthcare companies to keep a track record of a client's diseases, illnesses and the like. The template below can be even edited to make it specific for each patient. 

Use This Template

Test the Survey

In some cases, health, nutrition and lifestyle surveys can be a key way of pinpointing where patients and clients require the most assistance.

Depending on the goals they want to achieve and the challenges they are struggling with, you may want to know their your patients' food and exercise habits and whether they smoke. With the data from your lifestyle survey can help you make the key mind-body connections and focus on the healing part better.