Health Fitness Questionnaire


A health and fitness questionnaire is helpful in evaluating the health and physical fitness of an individual. This questionnaire helps to recognize the health problems and keep the individual guarded against lifestyle diseases that he may be exposed to. This questionnaire is mandatory when an individual is planning for enrolment into any of the sports or fitness activities.

Sample Health Fitness Questionnaire

Name of the person ___________________________

Contact number ___________________________

1. What do you do every day for keeping yourself healthy?

a) Indulge in many physical activities such as walking, swimming or jogging

b) Eat moderately on all days

c) Early to bed and early to rise

d) All of the above

2. Do you think a person should make a conscious effort to stay healthy?

a) Yes

b) No

c) Not sure

3. Do you have a family history of any of the ailments such as diabetes and blood pressure?

a) Yes

b) No

c) Not sure

4. Do you eat and drink at regular intervals?

a) Yes

b) No

5. Are you under any medication at present?

a) Yes Pl specify medication name ______________

b) No

6. Do you have any difficulty when you indulge in physical activity?

a) Yes

b) No

7. Do you suffer from any kind of allergies?

a) Yes Pl specify ______________

b) No

8. Did you undergo any kind of surgery in the past three months?

a) Yes Pl specify ______________

b) No

9. How frequently do you visit a doctor from the following time frames?

a) Every three months

b) Every six months

c) Every one year

d) Never

10. Do you think you are a healthy person and have never had any health problems in the recent times?

_________________________

11. Do you think it is healthy to exercise regularly?

a) Yes

b) No

12. Do you have any hearing impairment or eye sight?

a) Yes

b) No

Category: Health Questionnaire

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