Online Medical Questionnaire


An online medical questionnaire is a medical questionnaire that as the name suggests is found online and filled online. It deals with medical issues that involve an individual, institution or community. A medical questionnaire may be designed to find out several issues. These issues either concern an individual, institution or community. Examples of medical questionnaires include pre employment medical questionnaires, questionnaires on medical history or questionnaires seeking to find out medical services in a community. The answers given to the questions are used to draw the right conclusions on medical issues. Below is an example of a medical online questionnaire on the availability of medical services for children below the age of 5 in a community.

Online medical questionnaire on availability of medical services for children below the age of 5 in a community

How many hospitals/clinics do you have in your neighborhood?

_______________

How many of them are owned by the

Government _______

Private sector __________

(Please answer the following questions with a ‘yes or no’)

Are the clinics / hospitals accessible to everyone in the neighborhood?

_____________

Do the hospitals/clinics have a pediatric wing with qualified pediatric doctors?

Government ________          Private ____________

Kindly indicate whether the following services are offered for free in both government and private hospitals/clinics for children below the age of 5.  Answer ‘yes’ for the service provided and ‘no’ for the one that is not provided.

Government                        Private

Vaccinations                                ______________                    _____________

Post natal care                             ______________                   ______________

First aid                                          ______________                    ______________

Is the cost of medical services for children below the age of 5 affordable?

Yes ______         No ________

……………………………………

Category: Medical Questionnaire, Online Questionnaire

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