Medical Health Questionnaire


A medical questionnaire is usually given to people for purposes of identifying their health status. The medical questionnaire is a tool used in different institutions throughout the country for purposes of providing accurate information regarding the health conditions of people therein. The data provides information regarding individuals, which is vital in case of health-related emergencies. In some organisations, the medical health questionnaire is part of the recruitment process, whereby it is sent to the applicant, who fills it and sends it to the potential employer. The organisation then scrutinizes the questionnaire, and contacts the applicant’s general practitioner just in case they need clarification on something.

Medical Questionnaire for Veterinary Job Applicants

Name______________________________ DOB__________________

Sex_______________________

Qualifications    _________________________

_________________________

Circle the description that best describes your previous handling of animals

a.I have worked previously with animals (includes conducting procedures on animals, restraining them, collecting specimens, or administering substances to the same)

b.I am just learning about handling animals but am catching up pretty well

c. I have only handled family pets, but am willing to expand my knowledge to other animals.

Tick the animals you have worked with previously

Amphibians/ birds/ cattle/ goat/ horse/ marine mammals/ fish/ poultry/ rabbits/ rats/ reptiles/ rodents/ sheep/ swine/ other (specify) _______________________

Medical History

1.Have you received any tetanus vaccination or booster recently? _________ If yes, please  specify the date

2.Have you had a rabies vaccination or titer lately? __________ if yes, state the date___________

3.Do you have any known allergies to animals, animal dust, pollen, food, mold or plants? ______________. If yes, please specify___________________

4.Are you asthmatic? ____________

5.Do you have a family history of eczema, hay fever or asthma-like symptoms? ______

Category: Health Questionnaire, Medical Questionnaire

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