Parkwest Medical Center / Covenant Health

Health Risk Appraisal Questionnaire

Before beginning this questionnaire, please have your medical information at hand, including your height, weight, approximate dates of most recent preventive services and health screenings, and blood pressure and cholesterol measurements, if known. While none of this information is required, including it will make your HRA Profile more accurate and complete.

You may submit a questionnaire only when you are eligible. You will be informed of eligibility at the appropriate time. You may return here to see your current report whenever you wish.

Your privacy comes first! Your Last Name and Last 5 digits of Social Security Number are required to confirm your eligibility to use this HRA. Beyond this purpose, your information is considered anonymous. Your personal health information is held in confidence by the University of Michigan Health Management Research Center and is never shared or used without your permission, except in aggregate, anonymous form for scientific research.

Parkwest may receive your identified personal health information for intervention programs based upon identified health risks. Your organization and others responsible for tracking your participation may be informed of your participation (never any personal health information shared) in this HRA for incentive purposes.

Last Name Last 5 digits of Social Security Number
HRA Password
For the privacy of your information,
a. If this is your first time here, please enter any password of your choice, using at least four letters or digits. Record and save this password to use when you return here other times. Enter your chosen password twice, once in each box.
b. If you've already registered a password, please enter it once here. This password is not required to enter to complete a questionnaire. However, without it, for the privacy of your information, your report will not include any comparison results from your previous questionnaire.

I've lost my password

To personalize your questionnaire:


Cigarette Smoking
How would you describe your cigarette smoking habits?
Still smoke cigarettes
Used to smoke cigarettes
Never smoked cigarettes

The Health Risk Appraisal is not a substitute for a medical exam. If you have health concerns or if the report raises questions, please consult your physician or a health professional to review the results with you

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Dec 7, 2016; 21:02:47 EST Feedback: