Health Survey Template

We're trying to get clearer picture of the health of our citizens.Let's start with your date of birth.Could you tell us your weight in kilos?How tall are you in cm?For instance, 158, or 195.Do you smoke?How would you rate your overall health?Do you currently suffer from any of these conditions?

Heart disease, Cancer, Diabetes, Respiratory disease, Allergies, Headaches

Would you say that you have any mental health challenges or concerns (even if they're not severe)?What are you struggling with?

Anxiety, Depression, Sleep problems, Stress, Burnout, Other

How much would you agree with this statement: "I have the resources and support I need to look after my health."Thank you for your time and honesty, it's very valuable.

Collect up to 3.5x more data with Typeform

Complex data collection made simple

Calling all medical professionals and researchers: there’s a better way to survey health, for your patients and for you. This health survey template can be easily customized to fit your research goals and it automatically churns out reports. Plus, people will love how easy it is to fill out.

With Typeform, you can customize everything

Change text, colors, and even logos to match look and feel of your brand. Then embed forms smoothly onto web and email.

Make forms feel effortless to fill out. Pace questions, call people by their name, and adapt the flow based on the data they share.

Stay efficient by connecting forms to your workflow. Typeform integrates with 120+ tools including Slack, Zapier, and HubSpot.

Health survey FAQs:

Surveying ten patients or hundreds? Already dreading that time you have to spend in spreadsheets, copy-pasting answers? Let’s cut down on the busywork. Our integrations help you automatically create clear, insightful reports that will help you analyze data in an instant.

New responses can be seamlessly transferred over to tools like Excel Online and Google Sheets, which then turn them into charts and graphs. You just sit back and watch it all unfold.

Before you send out your form, there are two things you should do:

Set up a BAA (Business Associate Agreement) with us

Typeform is a HIPAA-compliant company, so all the healthcare-related info you process with us is legally airtight. But for you to be 100% HIPAA compliant, you’ll first need to set up a BAA. To do this you would need to talk to us about our enterprise plan, which you can do by filling out this Typeform, or contacting your Typeform account manager.

Check the local data collection laws

Data collection laws aren’t a one-size-fits-all thing—especially when there’s sensitive medical info involved. So before hitting share, seek advice from a local lawyer to make sure you’ve covered everything.