Health Assessment Questionnaire Template

This health assessment questionnaire template can be used by any health care provider in order to better understand the health status of their patients and to smooth the whole medical experience. It can be used in various ways, as part of the medical registration process or in order to measure outcomes of certain diseases, rheumatoid arthritis, drug side effects and other.

Create secure surveys and questionnaires with 123FormBuilder or browse our collection of health assessment forms that we’ve designed for medical professionals like you. Upon request, you can build HIPAA-compliant questionnaires and forms with an Enterprise subscription plan on 123FormBuilder.

Customize template

This questionnaire sample is intended to help you design a series of health questions for patients. Personalize this form according to your choice of fonts and colors and set up multiple recipients and custom autoresponders. Drag and drop advanced fields such as checkboxes and Likert scales on your questionnaire. It’s all yours: no coding skills required.

Publish template

It’s easy to publish this form anywhere you want to start a dialogue to raise health awareness. Embed it on your website, post in health education groups on social networks, link from an email. The questionnaire is mobile-responsive, so it will look good on computers and smartphones.

Collect & manage data

Feel safer knowing the reports of sensitive health issues are housed in a secure database at 123FormBuilder. You can export the results as Excel, CSV, or PDF files or generate easy-to-read charts and graphs that may suggest trends and possible determinants of health.

Optimize processes

Using an online form to administer your survey on health benefits patients as well as physicians and public health professionals. Answering an online questionnaire can encourage candor as individuals feel more at ease than in a face-to-face interview. With better data, you can provide quality health tips to improve lives.