Inova Center for Wellness & Metabolic Health

Weight and Health Questionnaire

Welcome to Inova Center for Wellness and Metabolic Health. Our Weight and Health Questionnaire is designed to give you and our clinicians a clear picture of your current health status, lifestyle habits, and personal goals. The information you provide helps us create a personalized plan that addresses weight management, metabolic concerns, and overall wellbeing.

How the questionnaire works

Our questionnaire is divided into four sections. You can complete it online or print a copy and bring it to your first appointment.

1. Personal & Medical Information basic demographic data and health history.
2. Lifestyle & Habits diet, physical activity, sleep, and stress.
3. Weight History & Goals past attempts, current concerns, and future objectives.
4. Metabolic Health Markers lab results, symptoms, and family patterns.

Key topics covered

• Current weight and height to calculate your Body Mass Index (BMI) and assess trends.
• Medical conditions diabetes, thyroid disorders, cardiovascular disease, etc.
• Medication review including prescription, overthecounter, and supplements.
• Nutrition intake typical meals, snacks, portion sizes, and hydration.
• Physical activity frequency, intensity, and types of exercise.
• Sleep quality duration, consistency, and sleeprelated issues.
• Stress & mental health work, relationships, and coping strategies.
• Family health history obesity, metabolic syndrome, heart disease.
• Laboratory values glucose, cholesterol, HbA1c, thyroid hormones, etc., if already available.

Sample questionnaire (online version)

After you submit the questionnaire, a member of our multidisciplinary team will review your answers and contact you within 48 hours to discuss next steps.

Start the Online Questionnaire

What happens after you complete the questionnaire?

1. Comprehensive Review Our physicians, dietitians, and exercise physiologists evaluate the data together.

2. Lab Assessment (if needed) We may order fasting glucose, lipid panel, thyroid tests, or other markers to fill gaps.

3. Personalized Care Plan Based on your answers, we develop a plan that may include nutrition counseling, medication adjustments, behaviorchange coaching, and physicalactivity prescriptions.

4. Followup Schedule Youll receive a timeline for checkins, lab retesting, and goaltracking.

Benefits of using the questionnaire

• Efficiency Saves time during your first visit; clinicians have essential information upfront.
• Precision Captures details that might otherwise be missed in a brief conversation.
• Engagement Encourages you to reflect on habits and set realistic objectives before meeting the team.
• Continuity The same data set can be referenced on future visits, allowing us to track progress objectively.

Frequently Asked Questions

Is my information confidential?

All data is stored in a HIPAAcompliant system and accessed only by authorized members of the Inova Wellness team.

Can I complete the questionnaire on a mobile device?

Yes. The online form is responsive and works on smartphones, tablets, and computers.

What if I dont know some of the lab values?

Thats fine. Well order the necessary labs after the initial consultation.

How long does it take to fill out?

Most patients finish within 1015 minutes.

Do I need a doctors referral?

No referral is required. You can selfschedule an appointment after completing the questionnaire.

Contact Inova Center for Wellness & Metabolic Health

Phone: (555) 1234567
Email: wellness@inovahealth.org
Address: 1234 Health Way, Suite 200, Anytown, State, ZIP

Take the first step toward a healthier youstart the questionnaire today and let Inovas expert team guide you toward lasting, sustainable results.