JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Wellness Self-Assessment
This form will ask you a few questions about your wellness. It will take less than 10 minutes to complete. The questions come from the Princeton UMatter Wellness Self Assessment and the County Health Rankings report.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your phone number
Your answer
What is your age? Enter a number.
Your answer
Would you say that in general your health is
Excellent
Very good
Good
Fair
Poor
Don't know/not sure
Clear selection
The next sections will take approximately 5-10 minutes to complete.
Next
Page 1 of 8
Clear form
Never submit passwords through Google Forms.
This form was created inside of Ujima Institute.
Report Abuse
Forms
