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Health survey

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

Secured
Health survey
1

Name of the participant

Select one or more answers
Health survey
2

What do you say about your over all health

Select one or more answers
Health survey
3

Do you have any chronic diseases

Select one or more answers
Health survey
4

Do you have any hereditary condition diseases

Select one or more answers
Health survey
5

Are you habitual to drugs and alcohol

Select one or more answers
Health survey
6

Over the past 2 weeks, how often have you felt nervous anxious,or on edge

Select one or more answers
Health survey
7

Are there under age of 12 in your house hold

Select one or more answers
Health survey
8

How often do you get a health check up

Select one or more answers
Health survey
Health survey
9

Gender

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Health survey
10

In which year you born

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Health survey
11

To which ethnic group do consider yourself belonging to

Select one or more answers
Health survey
12

Would you describe the area in which you live as being city,town,village or country side

Select one or more answers
Health survey
13

How many people are living in tour household, including you

Select one or more answers