A general health survey questionnaire is aimed at evaluating the general health of the individuals participating in the survey. This survey questionnaire is used in preparing various kind of market research or other medical based research reports which help in assessing the general health pattern of people. Given below is a sample of general health survey questionnaire:
Sample General Health Survey Questionnaire
Name of the Participant : _________________________________________
Full Address of the Participant : __________________________________________
Occupation of the Participant : __________________________________________
Date of Birth of the Participant : __________________________________________
Email Address of the Participant : __________________________________________
Contact Number of the Participant : __________________________________________
Kindly answer all the questions and share the correct information (The information provided here will be kept confidential always and not shared with anyone):-
Q1. How frequently do you consume alcohol? Please specify the frequency provided below as applicable?
Q2. How would you rate your overall health?
Q3. Are you suffering from any specific disease or illness, please describe the signs and symptoms experienced by you on account of it?
Q4. Is there a family history of any of the following diseases?
b) High blood pressure
d) Heart Diseases
Q5. Have you undergone any surgery or serious treatment in past one year? If yes, then please provide details?
Q6. Please specify the activities that you indulge in order to maintain good levels of fitness and overall health?
a) Brisk walking
d) Others Pl specify____________
Q7. How often do you fall ill during a year? Please specify the number of times you have not been able to carry on routine work such as going to office etc on account of your illness?
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