A 10-item patient “Health Habits Questionnaire” was developed that included counseling topics recommended by the US Preventive Services Task Force. Patient education brochures for each of these topics were designed and displayed in examination rooms. The questionnaires were to be given to every adult presenting to a family medicine residency clinic for a physical examination. Charts of patients receiving physical examinations were audited. Of 368 visits, 206 questionnaires were completed. Patients who completed the questionnaire were significantly more likely to have chart documentation of counseling about seat-belt use, exercise, stress, alcohol and other drug use, and dental health. The topic areas that had no significant improvement in documentation had higher counseling documentation rates than those that improved. The Health Habits Questionnaire appears to be a useful tool to improve counseling documentation, particularly for those habits that may otherwise receive little counseling.