Community Health Campaign Survey Form
We appreciate your participation in our community health campaign. Please answer the following questions.
Full Name
First Name
Last Name
Age
Gender
Male
Female
Other
Prefer not to say
Do you have any chronic health conditions?
Yes
No
If yes, please specify
How often do you exercise per week?
Never
1-2 times
3-4 times
5 or more times
Rate your overall health
1
2
3
4
5
What health topics are you most interested in?
Additional comments or suggestions
Submit
Should be Empty: