A medical education questionnaire is used to test the awareness of people as far as their knowledge in the field of medicine is concerned. Such a questionnaire can be provided by the hospital to their patients or a school may use medical education questionnaire in order to check the awareness of their students regarding medical education.

Such a questionnaire contains variety of questions related to the medical field which can be objective, as well as subjective in nature. Given below is a sample of medical education questionnaire, to which you can refer in the future.

Sample Medical Education Questionnaire:

Today’s date:

Name of the person:


Sex: M/F

Date of birth:   (dd/mm/yy)



Residential address:

Mobile number:

Email id:

Q1. What is your blood group?

  • A negative
  • B negative
  • O negative
  • AB negative
  • A positive
  • B positive
  • O positive
  • AB positive

Q2. Do you get your eyes tested at regular intervals?

  • Yes
  • No
  • Sometimes
  • Rarely

Q3. Which of the following options do you follow in case of a high fever?

  • Test my fever using a thermometer and then take a medicine
  • Go straight to the doctor in order to get the medication
  • Test my fever using a thermometer and then consult a doctor for medication
  • Just wait for the fever to get down

Q4. What according to you is the best way of controlling one’s blood pressure?

  • Reducing the quantity of salt in your daily diet
  • Including regular exercise as a part of your daily routine
  • Maintaining your weight
  • Using apt medication
  • Reduction in alcohol consumption
  1. Which of the following body part gets most affected by smoking?
  • Heart
  • Lungs
  • Kidney
  • Skin
  • Small intestine
  • Large intestine