Health & Wellbeing Review (PAM)

On this form there are some statements that people sometimes make when they talk about their health. Please indicate how much you agree or disagree with each statement as it applies to you personally, by selecting your answer.

There are no right or wrong answers, just what is true for you. If the statement does not apply to you, please select ‘N/A’.

This form is copyrighted (and approved for use by) Insignia Health, LLC.

Health & Wellbeing Review (PAM)

Health & Wellbeing Review (PAM)

Patient's Details

Please use this date format: DD/MM/YYYY.


I am the person who is responsible for taking care of my health. *
Taking an active role in my own health care is the most important thing that affects my health. *
I am confident I can help prevent or reduce problems associated with my health. *
I know what each of my prescribed medications do. *
I am confident that I can tell whether I need to go to the doctor or whether I can take care of a health problem myself. *
I am confident that I can tell a doctor or nurse concerns I have, even when they do not ask. *
I am confident that I can carry out medical treatments I may need to do at home. *
I understand my health problems and what causes them. *
I know what treatments are available for my health problems. *
I have been able to maintain lifestyle changes, like healthy eating or exercising. *
I know how to prevent problems with my health. *
I am confident I can work out solutions when new problems arise with my health. *
I am confident that I can maintain lifestyle changes, like health eating and exercising, even during times of stress. *