Health survey is a useful means of gathering information about general or specific health concerns of an individual. On the basis of this data, policy makers, companies or medical practitioners can not only get an idea of the person’s health but also formulate strategies and suggest areas of improvement. This survey mainly targets the metro-centric youth to collect inputs about their physical/mental health and accordingly develop programmes for a healthy lifestyle.

Health Survey Questionnaire Sample

1) Please specify which age group you belong to:

a. 16-21

b. 22-28

c. 29-35

d. Above 35

2) Sex:

a. Male

b. Female

3) Annual income:

a. None (Student)

b. Below Rs 1 lakh

c. Rs 1 lakh-2 lakh

d. Above Rs 3 lakh

4) How would you describe your health generally?

a. Very good

b. Good

c. Average

d. Bad

6) In the past six months, have you suffered from any illness that required medical attention?

a. Yes

b. No

7) How often do you exercise in a week?

a. Every day

b. More than 4 times

c. Less than 4 times

d. None

8) Do you smoke or drink?

a. Yes

b. No

9) How often do you go out to eat at fast food restaurants?

a. Every week

b. Once in 14 days

c. Once a month

10) How many hours do you sleep every day?

a. More than 8 hours

b. 4-8 hours

c. Less than 4 hours

11) How much time do you spend on the internet?

a. More than 3 hours

b. 1-3 hours

c. Less than 1 hour

12) What do you use the internet for?

a. Checking mails, surfing

b. Social networking

c. Business networking

13) Do you feel stressed to the point that you would see a doctor/counsellor?

a. Yes

b. No

1 Comment

  1. janet says:

    Looking to design a survey asking patients and families about an information booklet,whether it was helpful, about the ward they have been admitted to.Suggestions?

Leave a Reply

Your email address will not be published. Required fields are marked *