JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Health Prevention Awareness Form
Strictly Created by Royston Tan
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name:
*
Your answer
Contact Number:
*
Your answer
Age:
*
Your answer
Residential:
*
Singapore, Malaysia, The States...etc
Your answer
1) Is anyone around you suffering from diabetics, high blood pressure or any chronic diseases.
*
Family, Relatives, Friends...etc
Yes
No
2) Do you know anything about Health Prevention
*
Your knowledge and understanding of Health Prevention
1
2
3
4
5
6
7
8
9
10
3)How often do you and your family members visit the doctor annually(Yearly).
*
At least once a year
Twice a year
3times a year
More then 3 times a year
4)Do you think today you are healthy?
*
Yes
No
5)Are you doing anything about your health.
*
Yes
No
6)Would you like to know more about health prevention for yourself and your Family.
*
Yes
No
Feedback/Remarks:
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
