General Health Questionnaire Form
General health questionnaire form is a pre-developed document presented by any health or philanthropic organization for gauging the quality of overall health standard of the general mass. Hence, such a document must elucidate all the important aspects needed to be maintained for a quality health standard.
Sample General Health Questionnaire Form
Name of the participant _________________________
Age ______________
Address __________________
The questionnaire form is prepared and presented by _________________
1. Do you have any major illness? If yes, describe elaborately.
____________________________________________________________________________________________
2. Have you undergone any surgery or serious medical implications in recent times? If yes, specify when and elaborate the kind of treatment.
____________________________________________________________________________________________
3. Are you suffering from any age problems or lifestyle disorder? If yes, then specify in details about it.
____________________________________________________________________________________________
4. Do you have any regular habits of smoking, tobacco inhaling, consuming alcohols or any other drugs? If yes, then mention briefly about your habit and how long you are addicted to it.
____________________________________________________________________________________________
5. Do you have nutrition idea about the diet you are consuming? If you are aware of it, then please specify your diet.
6. In general, rate your health status on a scale of 10 so that your overall well being could be gauged.
_________________________
Download General Health Questionnaire Form
Category: Questionnaire Forms
