A health education questionnaire is a questionnaire that helps in analyzing a person’s health education. The aim of such questionnaires is to provide people with a relevant and user friendly instrument for evaluation of a person’s level of education in health matter. These questionnaires give valuable information to researchers, clinicians and most importantly the policy makers about the awareness of various disorders prevalent in the world in general.

Sample Health Education Questionnaire:

This health education questionnaire is being distributed by ABC Health Care in order to grasp the level of health awareness among different sects of the society. Here are a few simple questions for you answer:

  1. Name:
  1. Age:
  1. Address:
  1. Phone:
  1. What do u do(occupation):
  1. Please tick if you suffer from any of the following chronic disorders:

a) Diabetes     b) Asthma    c) Heart Disease    d) Lung disease

e) Cancer        f) COPD     d) other (please specify)

  1. In general, what would you say about your health:

a) Excellent     b) Very good    c) good     d) Fair    e) Poor

  1. Do you go to get your gum check regularly?
  1. Do you walk/jog or run regularly?
  1. Has your health interfered with normal social activities?
  1. Does your health interfere with normal household chores?
  1. Do you have any kind of persistent body ache?
  1. How often do you visit your general physician?
  1. How many times in the last 1 year have you been hospitalized?
  1. Do you suffer from shortness of breath?
  1. Do you get easily fatigued?
  1. Do you have any other health problems or issues you want to give in detail: