Health Risk Questionnaire

We ask that you take the time to complete this form so that we can help you and your providers better manage your health care needs. Filling out this questionnaire is important, as it will give your care team key information about you.

Your answers will be kept private and shared only with your personal doctor (also called primary care physician) and other members of your care team as needed. This allows them to support you better as you work toward your health goals.

* Required field

Sharp Direct Advantage is offered by Sharp Health Plan. Sharp Health Plan is an HMO with a Medicare contract. Enrollment with Sharp Health Plan depends on contract renewal. Read the full disclaimer.

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