Health Questionnaire Questions
Health questionnaire questions are medically relevant and focused at deriving maximum information from a participant with respect to their current and past medical conditions and health issues. A health questionnaire is used by medical institutions and health experts during patient treatments.
Sample Health Questionnaire Questions:
Name of the participant: ____________________________
Name of the family Doctor: __________________________________
Doctor’s phone: __________________________________
Q1. When did you last visit a doctor or physician?
- Last week
- Fortnight back
- A few weeks back
- Last month
- A few months back
Q2. Are you allergic to any of the following?
- Animal Hair
- Insect bite
- Dust mite
- Sesame seeds
Q3. Do you suffer from any of the following skin problems?
- Seborrheic dermatitis
- Skin cancer
- Necrotizing fasciitis
- Athlete’s foot
Q4. What were the results for the following tests conducted previously?
- Blood Pressure: ___________________________
- Systolic (mm Hg) : ___________________________
- Diastolic (mm Hg) : ___________________________
- Blood Sugar: ___________________________
- Fasting blood sugar level (FBS) : ___________________________
- Random blood sugar level(RBS) : ___________________________
- 2-hour postprandial blood sugar level: ___________________________
Q5. Are you currently on any type of medication? If yes, then please mention the disorder and the name of medicine/drug.
Q6. Do you have cholesterol? If yes then please provide the following levels
- LDL cholesterol:__________________
- HDL Cholesterol:__________________
Category: Health Questionnaire