00:00:00
Scan QR code to answer
Student Health and Wellness Audit Form Template
录音中...
Please complete this form to help us evaluate your current health and wellness.
*
1.
Student's full name
2.
Student's date of birth
3.
Gender identity
Female
Male
Non-binary
Prefer not to say
4.
Do you have any allergies?
Yes
No
5.
If yes, please list your allergies
6.
Do you have any chronic health conditions?
Yes
No
7.
If yes, please list your chronic health conditions
8.
On average, how many hours of sleep do you get per night?
9.
How many times per week do you engage in physical activity?
Never
1-2 times per week
3-4 times per week
5 or more times per week
10.
Rate your overall wellness on a scale of 1 to 10
1
10
11.
Do you have any dietary restrictions?
Yes
No
12.
If yes, please list your dietary restrictions
13.
Any additional comments or concerns?
Evaluation object score
AI Probing
End Answering
Send
End Answering
