Do you ask your doctor what he or she does for his or her personal wellness? 1= Never, 3 = Sometimes, 5 = Always

Enter score 1 2 3 4 5

Do you schedule a regular appointment with your doctor? 1= Never, 3 = Sometimes, 5 = Always

Enter score 1 2 3 4 5

Do you ask your doctor how many people with your condition he or she has treated? 1= Never, 3 = Sometimes, 5 = Always

Enter score 1 2 3 4 5

Do you question what medication you are taking and why you are taking it? 1= Never, 3 = Sometimes, 5 = Always

Enter score 1 2 3 4 5

Do you ask your doctor what areas of your health you should work on before your next visit? 1= Never, 3 = Sometimes, 5 = Always

Enter score 1 2 3 4 5

Do you verify that the information sources you use for checking on your symptoms and other health issues are trustworthy? 1= Never, 3 = Sometimes, 5 = Always

Enter score 1 2 3 4 5

Do you have or have you thought of a plan for your health?
1 = No, 3 = Sometimes, 5 = Yes

Enter score 1 2 3 4 5

Do you Google your symptoms before visiting a doctor? 1= Never, 3 = Sometimes, 5 = Always

Enter score 1 2 3 4 5

Do you feel your health is important to you? 1 = No, 5 = Yes

Enter score 1 2 3 4 5

Do you know of your health strengths and weaknesses?
1 = No, 3 = I have some idea, 5 = Yes

Enter score 1 2 3 4 5

Do you ask the question “what is the best way to lose weight”? 1= Never, 3 = Sometimes, 5 = Always

Enter score 1 2 3 4 5