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HRSA Logo My Bright Future: Physical Activity And Healthy Eating Guide for Adult Women My Bright Future: Physical Activity And Healthy Eating Guide for Adult Women
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Talking With My Health Care Provider

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My Health Care Visit

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Setting My Goals

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What I Should Know

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To Be Completed by My Health Care Provider

My Health Care Visit

These pages are for your health care provider to fill in. Now is the time for you and your health care provider to review the information in this booklet.

Date: ____________________

Height (inches): _____________________

Weight (pounds): _________________________

BMI: ___________________ (Use chart below to find where height and weight meet.)

The body mass index (BMI) is a measure of body fat based on height and weight (not just weight alone). A BMI of 25 or higher means you are overweight or obese and at a higher risk for high blood pressure, heart disease, stroke, type 2 diabetes, and other conditions. (Note: People who are muscular tend to have higher BMI scores without necessarily being overweight.)

BMI Table

Underweight: Less than 18.5 Underweight: Less than 18.5
Healthy Weight: 18.5 - 24.9 Healthy Weight: 18.5 - 24.9
Overweight: 25 - 29.9 Overweight: 25 - 29.9
Obese: 30 and above Obese: 30 and above

Other measurements to keep in mind:

Blood pressure: _____________________

Cholesterol level: _____________________

Current Physical Activity Assessment:

  • On target
  • Recommend changes

Current Nutrition and Eating Habits Assessment:

  • On target
  • Recommend changes

Health Care Provider’s Recommendations:

  1. ___________________________________________________
  2. ___________________________________________________
  3. ___________________________________________________

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Department of Health and Human Services