Health Screening Questionnaire Template

A Health screening questionnaire template is a document that helps to frame a questionnaire that aims to assess the health condition of an individual.

“You can Download the Free Health Screening Questionnaire Template form, customize it according to your needs and Print. Health Screening Questionnaire Template is either in MS Word, Excel or in PDF.”

Sample Health Screening Questionnaire Template

Health Screening Questionnaire Template

Download Health Screening Questionnaire Template

Name___________ Sex______ Age_______

Address___________ Phone________ Email______

(This section asks for the personal information of the individual.)

Questionnaire

(This is the main part of template used for health screening questions.)

1. Has your doctor ever cautioned you to take physician’s approval before joining any workout session?

A. Option 1.

B. Option 2.

C. Option 3.

D. Option 4.

2. Have you ever-contacted physician for any blood pressure trouble?

A. Option 1.

B. Option 2.

C. Option 3.

3. Do you visit to hospital for regular health check-ups?

A. Option 1.

B. Option 2.

4. Do you have any chronic dieses history in your family?

A. Option 1.

B. Option 2.

C. Option 3.

5. Do you presently suffer from any ailment or disease?

A. Option 1.

B. Option 2.

Category: Questionnaire Templates

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