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 Prescriptions for Health

These forms are to enhance patient and provider visits. They are designed to start a dialogue between patient and provider regarding improving health behaviors. The health prescription offers ideas related to physical activity, body image and food and eating. 

Food and Physical Activity for Health Tip Sheet (PDF format)

This sheet includes directions for health care providers to use the two forms. It also shares ideas for making large patients feel welcome. 

Food and Physical Activity Habit Inventory (PDF format)

This form is completed by the patient. Patients complete the form providing an overview of their physical activity and eating habits. 

Food and Physical Activity for Health (PDF format)

Using the habit inventory, this form becomes a prescription for health. The form can help patients set some health-related goals and includes ideas for meeting those goals.


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WIN the Rockies: University of Wyoming ~ Montana State University ~ University of Idaho

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