Adult well-care questionnaires

Visit and screening schedule

To see Kaiser Permanente recommendations for well-care visits (preventive care), go to Adult well-care visits, screenings, and immunizations.

Fill out your health profile

If you've scheduled a well-care visit at a Kaiser Permanente medical office, please fill out a Health Profile before your visit. This is an online questionnaire. The information helps your health care team provide you with the best care.

It takes about 20 minutes to fill out. Your responses and patient summary report will become part of your medical record if you get primary care at a Kaiser Permanente medical office.

After you submit the questionnaire, you'll receive an online report with personalized recommendations on how to lower your risk for certain diseases and conditions. You can talk with your provider about your patient report and recommendations during your visit.

If you prefer not to fill out a Health Profile, you can print an appropriate questionnaire below and fill it in by hand. Take your completed form to your well-care appointment so that your doctor can include it as part of your visit. Additionally, an electronic version of the paper questionnaire may be sent to you through your member account prior to your appointment.

• Young adults 18 to 21 (PDF) 
• Adults 22 to 64 (PDF) 
• Adults on Medicare or 65+ (PDF) 
  

Clinical review by Kimberly Knight, RN
Kaiser Permanente
Reviewed 06/08/2021