Routine Physical Exam Frequency Survey
Help us understand how often you undergo routine physical exams and your attitudes toward preventive health checkups.
Full Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
How often do you have a routine physical exam?
*
Once a year
Every 2-3 years
Less than every 3 years
Never
What motivates you to attend routine physical exams? (Select all that apply)
Doctor's recommendation
Personal health awareness
Family history of illness
Employer requirement
Other
If you do not attend routine physical exams regularly, what are the main reasons?
Cost concerns
Lack of time
Don't feel it's necessary
Difficulty scheduling appointments
Other
On a scale of 1 to 5, how important do you think routine physical exams are for maintaining good health?
*
Not important
1
2
3
4
Very important
5
1 is Not important, 5 is Very important
How satisfied are you with your most recent routine physical exam?
1
2
3
4
5
Please indicate your agreement with the following statements about routine physical exams:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Routine exams help detect health issues early.
1
2
3
4
5
I feel comfortable discussing my health concerns during exams.
6
7
8
9
10
I believe routine exams are worth the time and cost.
11
12
13
14
15
I plan to continue having routine exams in the future.
16
17
18
19
20
What would encourage you to attend routine physical exams more regularly?
Any additional comments or suggestions regarding routine physical exams?
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