General Health Appraisal Form Template
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General Health Appraisal Form
Please complete this General Health Appraisal Form Template to assess and document an individual’s overall health condition.
Personal Information
Name
Date of Birth
Gender
Male
Female
Phone number
Address
Medical History
Current Medications
Allergies
Chronic Conditions
Previous Surgeries
Lifestyle Factors
Dietary Habits
Physical Activity
Sleep Patterns
Substance Use
Mental and Emotional Health
How would you rate your stress levels on a scale of 1-10?
Have you ever been diagnosed with a mental health condition? If yes, please provide details.
Preventive Health Practices
Are your vaccinations up-to date?
Occupational and Environmental Factors
Describe your current occupation and any potential occupational hazards.
Health Goals
What specific health goals would you like to achieve in the next six months?
Declaration:
I, the undersigned, declare that the information provided in this General Health Appraisal Form is accurate to the best of my knowledge.
Date:
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Thank you for completing this form!
If you have any questions, please contact [Company Email Address].
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