Online Health Assessment Questionnaire

Online health assessment questionnaires are a set of questions designed by various health related sites that help a person to evaluate how healthy he or she is. Such questionnaires guide respondents to assess their eating habits and lifestyles and pave way for better overall health.

Online health assessment questionnaire sample:

Name:  ________________                                                                             Age:__________

Gender: ________________                                                                      Country:                                                                                       __________

Q1:  Do you suffer from any of these?

  • High blood pressure
  • Diabetes
  • Insomnia
  • Stress
  • Heart problem
  • Obesity
  • High cholesterol

Q2:  Do you get your complete annual medical check up done?

  • Yes
  • No

Q3: Do you live a stressful, high paced life?

  • Yes
  • No

Q4: How would you rate your eating habits?

  • Healthy
  • Not so healthy!

Q5: Does your job demand you to sit in one place for long hours?

  • Yes
  • No

Q6: Do you exercise regularly?

  • yes
  • no

Q7: Do you drink lots of water?

  • Yes
  • No

Q8: Do you try to avoid processed food?

  • Yes
  • No

Q9: Do you get sound sleep at night?

  • Yes
  • No

Q10: Is your answer ‘yes’ to any of these?

  • I drink alcohol.
  • I smoke
  • I can’t survive without lots of caffeine.

Q11: Do you suffer from any allergies? Please specify:


Q12: Does anyone in your close blood relations, suffer from any serious medical condition?


Q13: When did you last get your medical checkup done?


Q14: Are you on any medication?


Q15: Do you take any vitamin supplements?

  • Yes
  • No

Category: Online Questionnaire

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