Your Health & Lifestyle Assessment
This assessment takes around 5–10 minutes to complete and reviews your body composition, cardiovascular health, blood sugar, cholesterol, lifestyle and daily habits. At the end you'll be sent a pdf of your Personalised Health Assessment Report highlighting areas performing well and those that may benefit from further attention. Let's begin....
Step 1: Personal Profile
Let's start with your basic information.
First Name:
*
Email
*
example@example.com
Date of birth:
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Gender:
*
Please Select
Male
Female
Step 2: Health Goals & Motivation
Select all the goals you’d like to achieve over the next 90 days.
Health Goals (Select all that apply):
Lose excess body fat
Increase energy and reduce fatigue
Improve my cholesterol
Lower my blood pressure
Improve my blood sugar control
Improve my sleep
Reduce stress and improve resilience
Build strength and fitness
Improve my nutrition
Reduce inflammation and ache
Better understand my blood test results
Reduce my future risk of chronic disease
Feel healthier and more confident
Create habits I can maintain for life
Other
Why is achieving these goals important to you right now?
Step 3: Body Composition
Enter your current body measurements.
Height (cm):
*
Weight (kg):
*
Waist Measurement (cm):
*
Measure around your waist at belly button level
Body Fat (%):
Enter your most recent reading from smart scales. Leave blank if unknown.
Waist-to-Hip Ratio (WHR)
BMI
Green_Status
Amber_Status
Red_Status
Waist_Status
WHR_Status
BodyFat_Status
Step 4: Cardiovascular Health
Enter your most recent cardiovascular health measurements, if known.
Resting Heart Rate (BPM):
From your smartwatch or recent measurement.
Blood Pressure (Systolic, mmHg):
The top (higher) number
Blood Pressure (Diastolic, mmHg):
The bottom (lower) number
Status_SBP
Status_DBP
Status_RHR
Step 5: Blood Test Results (Optional)
If you've had a blood test within the last 12 months, enter any results you know below. Otherwise, simply leave the fields blank.
HbA1c (mmol/mol):
Status_HbA1c
Do you have any concerns regarding blood sugar or prediabetes?
Total Cholesterol (mmol/L):
LDL Cholesterol (mmol/L):
HDL Cholesterol (mmol/L):
Triglycerides (mmol/L):
TC:HDL Ratio
Status_TC
Status_LDL
Status_HDL
Status_trig
Status_TC:HDL
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Step 7: Diet & Nutrition
Tell us about your eating and hydration habits.
Nutrition Goals (Select all that apply)
Weight management
Energy
Digestion
Disease management
General health
Current Diet Quality (Select one)
Balanced and varied
Mostly healthy
Inconsistent
Poor quality
How many meals do you typically eat per day:
Do you regularly snack between meals:
Please Select
Never
Occasionally
Often
Very often
Dietary style (Select one):
Omnivore
Vegetarian
Vegan
Pescatarian
Other
Preferred foods (text area):
Disliked foods (text area):
Food allergies (text area):
Food intolerances (text area):
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Protein Sources (Select all that apply)
Meat
Poultry
Fish
Eggs
Dairy
Legumes
Nuts
Supplements
How confident are you in getting enough Protein:
Please Select
Very confident
Somewhat confident
Not confident
How many portions of Fruit & Vegetables do you eat daily:
Please Select
0-1 portions
2-3 portions
4-5 portions
6+ portions
How regularly do you eat High-Fibre foods:
Please Select
Never
Once a week
Every other day
Every day
Average daily Water intake:
Please Select
Less than 1 litre
1-2 litres
2-3 litres
More than 3 litres
Daily Caffeine consumption in cups (coffee, tea, energy drinks):
Please Select
None
1-2 cups
3-5
6+
Status_Protein
Status_Fruit&Veg
Status_Fibre
Nutrition Challenges (Select all that apply)
Time for meal prep
Cost
Knowledge
Motivation
Social situations
Emotional eating
Medical conditions
Step 8: Physical Activity
Tell us about your current activity and exercise levels.
Average daily step count:
Please Select
less than 5000
5000 - 7500
more than 7500
Resistance training sessions per week:
Please Select
None
1-2
3-4
5 or more
Cardiovascular exercise minutes per week:
Please Select
Less than 90 minutes
90-149 minutes
150 minutes or more
Balance, Mobility and Flexibility per week:
Please Select
None
1-2 times per week
3+ times per week
Status_Steps
Status_Resistance
Status_Cardio
Step 9: Recovery & Wellbeing
Tell us about your sleep, stress and social wellbeing.
Average hours of sleep per night:
Please Select
Less than 6
6-8
More than 8
How would you rate your sleep quality?
Please Select
Good
Average
Poor
How would you rate your daily stress levels?
Please Select
Low
Moderate
High
How connected and supported do you feel?
Please Select
Poor
Average
Excellent
Feeling connected can positively influence stress, mental health and healthy lifestyle habits
Status_Sleephrs
Status_Sleepqual
Status_Stress
Status_Connection
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Step 10: Lifestyle Risks
Tell us about lifestyle habits that may affect your long-term health.
Alcohol frequency:
Please Select
Never
Occasional (1-2 times per month)
Moderate (1-2 times per week)
Regular (3+ times per week)
Weekly alcohol consumption (units):
Please Select
0 units: Non-drinker
1-14 units
15-28 units
More than 28 units
Do you smoke or use nicotine products:
Please Select
Never smoked
Former smoker
Occasionally
Daily smoker
Status_alchoholfreq
Status_alcoholunits
Status_smoking
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Privacy & Content
Please read the statements below before submitting your health assessment.
I confirm that I am aged 18 years or over.
*
Yes
I consent to Jon Bell Health collecting and processing the health information I provide in order to prepare my personalised health assessment and communicate with me about my results.
*
I consent
I'd like to receive occasional evidence-based health tips, news and updates from Jon Bell Health.
Yes, I'd like to receive these emails.
Important Information
This assessment is intended for educational and lifestyle coaching purposes only. It does not constitute medical advice, diagnosis or treatment and should not replace advice from your GP or another appropriately qualified healthcare professional. The assessment is based solely on the information you provide.
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