A Health education questionnaire template works as a basic draft for designing health education questionnaire. These types of templates help to know the awareness of the people regarding health education.
Sample Health Education Questionnaire Template
Name_____________
Sex _________ Age_______
Address________________ Phone____________ Email_________
(This section provides personal and contact details of the individual.)
Questionnaire
(This is the main part of template that shows the questions regarding health education.)
1. What is your general opinion regarding your health?
1. Option 1.
2. Option 2.
3. Option 3.
D. Option 4.
1. Do you regularly participate in fitness activities/workouts?
1. Option 1.
2. Option 2.
3. Option 3.
1. In last one year or less, how many times you have visited to physician?
1. Option 1.
2. Option 2.
3. Option 3.
4. Option 4.
1. Do you have any chronic dieses history in your family?
1. Option 1.
2. Option 2.
3. Option 3.
1. Do you get yourself regularly checked up by a doctor?
D. Option 1.
1. Option 2.
2. Option 3.
Download Health Education Questionnaire Template in Word Format