Template library · Assessments & screeners
Lifestyle & Habits Assessment template
Review current lifestyle habits across key wellness categories.
Review of lifestyle behaviors relevant to wellness
- 16 fields across 4 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Habits Reviewed
- Regular physical activity (3+ times/week)Tick box
- Balanced nutritionTick box
- 7+ hours of sleep per nightTick box
- Regular social connectionTick box
- Time for hobbies / relaxationTick box
- Limited alcohol or substance useTick box
- Regular preventive healthcare visitsTick box
Notes
- Habits client wants to build or changeText
Signatures
- Client SignatureSignature
- Date signed (client)Date
When to use it
Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.
How it works in MyWellOps
- Pick it from Documents.
- Send it to the client to complete, or fill it in together during a session.
- Each completed copy is kept on the client’s record, so earlier results are there to compare.
Spend less time on admin, more time with clients
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