Health questionnaire

Category: Health

This health questionnaire is a tool to examine and to survey the relation between smoking habits and health. This example questionnaire can be downloaded for free. This sample questionnaire is available in a Word format and you are free to adapt it at your own specifications. Just do it easy !


Preview of Health questionnaire

Smoking Survey

Health & smoking questionnaire

  1. 1.    How long have you smoked regulary ?

            Less than 1 year         □

            1-3 years                    □

            3-5 years                    □

            5-10 years                  □

            10-25 years                 □

            More than 25 years      □

  1. 2.    At what age did you start smoking ?

            Under 12        □

            12-16             □

            16-20             □

            20-29             □

            30 years +      □

  1. 3.    Which tobacco product do you regularly smoke ?

            Cigarettes       □

            Cigars             □

            Pipe                □

            Other              □



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