A medical survey template is a ready to use tool that is used to strengthen the structure of the surveys. It becomes easy and convenient for the sources who conduct the surveys if they utilize the medical survey template strategically. The template is used mainly by the students of medicine, medical analysts and pharmaceutical companies.

Sample Medical Survey Template:

Name: ______________________ (name of the person taking the survey)

Date of birth: __________________ (official date of birth)

Gender (male/female): _________________

1. Name the doctors/hospitals you visit for your medical check-ups.


2. Do you have a medical insurance?

a. Yes

b. No

3. If you have a medical insurance, name the insurance company. _____________________

4. Do you know the name of the basic medicines to be taken during customary ailments?

a. Yes

b. No

5. Do you have a first aid kit at your home?

a. Yes

b. No

6. Please mention the vaccinations which the children in your family have undergone.


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