Medical Questionnaire Template


A medical questionnaire template is a guideline of a medical questionnaire found on the Internet for people to download and use as a guideline when designing questionnaires of these type. Medical questionnaires cover a wide range of issue. The medical questionnaire template can be on varied issues including medical history, medical facilities and diseases. Medical questionnaire templates can be used by individuals or institutions when designing medical questionnaires. Below is an example of a medical questionnaire template.

Medical questionnaire template on the effect of HIV/AIDS in the society

Personal details

Surname                                       Middle name                         First name

_____________                              ________________                  _______________

Age _______

Please answer the following questions with ‘yes or no’

Do the local hospitals in your area have voluntary counseling and testing services?

__________________

Are they effective in reaching out to the local people on issues concerning HIV/AIDS?

_______________________

Have you ever been tested for HIV/AIDS?

_____________

Can you say that you have adequate information concerning HIV/AIDS?

_____________________________

Many HIV/AIDS patients face stigma from their friends and loved ones. Have you witnessed such a case?

____________________________

Are the local hospitals equipped with anti retroviral drugs (ARVs) for HIV/AIDS patients?

_______________________________

In most cases, the youth in a society are the most affected group by HIV/AIDS. Why do you think this is so?

___________________________________________

The main method of HIV/AIDS transmission is through sexual intercourse. What measures have been taken to educate people on prevention measures? (Tick where appropriate)

_____media (print, television, radio)

_____school curriculum

____public forums

_____Internet

________other

…………………………………………………………………………

Category: Medical Questionnaire

Comments are closed.

Copy Protected by Chetans WP-Copyprotect.