OptiHealth Baseline Assessment

The information you provide will help us connect you to a variety of free Lifestyle Medicine Services based on your needs and goals. Then, we'll track your progress and provide free recommendations to help ensure your success.
Baseline Assessment Data is analyzed by OptiHealth Institute and will be reported only in aggregate format for the advancement of Lifestyle Medicine. Personally identifying information will not be shared with anyone. ​Your right to privacy will always be protected.
This form is to be completed by you as the Research Participant. If needed, free assistance with this form is available at any full-service OptiHealth Research Facility - the gold markers on our Map.
Prerequisites - Research Participants:
  • Must be at least 18 years old.
  • Must take and keep on file their "Before Shots."
​Instructions: Take and keep on file your "Before Shots." These are for YOUR records only.
Have someone use your smart phone to take 4 photographs of you. Do not use "mirror shots" or "selfies." (often distorted angles).
  • 1 portrait-style view.
  • 1 full-length front view.
  • 1 full-length side view.
  • 1 full-length back view
Be sure to wear clothes that reveal your shape and size, such as in typical form-fitting work-out clothes.
​Keep these photos so that you can compare them with your "After Shots" that you will take in 6-12 months.
    1. Health Knowledge:
    2. Health Behavior:
    3. Demographics:
    4. Biometrics:
    6. Current Eating Pattern:
    7. Current Exercise Level:
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