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Health survey

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

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Health survey
1

Name of the participant

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2

What do you say about your over all health

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3

Do you have any chronic diseases

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4

Do you have any hereditary condition diseases

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5

Are you habitual to drugs and alcohol

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6

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

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7

Are there under age of 12 in your house hold

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8

How often do you get a health check up

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9

Gender

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10

In which year you born

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11

To which ethnic group do consider yourself belonging to

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12

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

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13

How many people are living in tour household, including you

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