Health Status Questionnaire Sample

Health status questionnaire can be used by any one and it mainly helps doctors, physicians or training couches to get an idea on how your physically and mentally placed.



A health status questionnaire can give you a valuable information about health, which can help others in evaluating you condition and know how to treat. The questionnaire form should consists of questions related to physical state, emotional state, stress evaluation and quality of life.

These kind of questionnaires can be very helpful for any individual who wants to know about himself. You can certainly make changes to your lifestyle you can answers the questions seriously and help get an answer. You can be good physically but lack confidence mentally. There are many who have issues with stress, answering such questionnaires can help you get an idea on how to reduce. We are living in a world where we can't avoid few things but we have a chance to reduce.

Below are few sample health status questionnaires that can help you.

Sample Health Status Questionnaire 


What kind of physical health problems you have?
Did you have any fractures in the body?
Do you feel pain in any parts of the body?
Do you often get clod and flu?
Do you have skin problem?
How often do you feel to drink water?
Do you get panicked for simple plans like headache?
Do you use pain killers to reduce the pain?
Do you often show disinterest in the work you do?
Do you get negative thoughts?
Do you people other beside you greater?
Do have feeling of EGO, jealous?
Do you get annoyed for no reason?
Do you yell at any one whom you think are not listening to you?
Do you love to be lonely?
Do keep talking to your self before doing an act?
Do you take your own decisions or follow the same as all?
Do you have any sleeping problems?
Do you love taking part in social activities?
Are you a spiritual person?
Do you share every thing with your family?
Have you tried improving your health life style?
Do you practice natural methods?
Do you crack jokes and try to keep every one happy?

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