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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 servey
1

Do you exercise regularly?

Please select the option that best describes your exercise routine.
2

Rate your overall health on a scale from 1 to 10.

Rate your overall health with 1 being the lowest and 10 being the highest.
3

Do you follow a balanced diet?

Please provide a brief answer about your dietary habits.
4

How many hours of sleep do you get on average per night?

Please enter the number of hours you sleep on an average night.
5

Are you a smoker?

Please select the option that best applies to your smoking habits.
6

Have you had any serious illnesses in the past year?

Please provide information about any serious illnesses you have had in the past year.
7

How often do you experience stress?

Please select the option that best describes your stress levels.
8

Do you drink alcohol regularly?

Please select the option that best describes your alcohol consumption habit.
9

How often do you engage in physical activities?

Please provide information about how often you engage in physical activities.
10

Are you currently under any medication?

Please select the option that best applies to your medication status.
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