Disease Prevention Pathology Assessment Form
Disease Prevention Pathology Assessment Form. Please complete all sections to help us assess key factors related to disease prevention in a pathology context.
Age Group
*
Please Select
Under 18
18-25
26-40
41-60
61+
How often do you engage in regular physical activity?
*
Daily
Several times a week
Once a week
Rarely
Never
Rate your knowledge of disease prevention strategies.
*
1
2
3
4
5
How often do you participate in preventive health screenings?
*
Annually
Every 2-3 years
Rarely
Never
Please indicate your agreement with the following statements.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I am aware of common risk factors for disease.
1
2
3
4
5
I follow recommended hygiene practices.
6
7
8
9
10
I seek reliable health information regularly.
11
12
13
14
15
How confident are you in your ability to prevent disease?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Do you currently use any tobacco products?
*
Yes
No
Former user
How often do you consume fruits and vegetables?
*
Daily
Several times a week
Rarely
Never
In the past year, have you received any recommended vaccinations?
*
Yes
No
Not sure
Please share any additional comments or concerns related to disease prevention.
Submit Assessment
Should be Empty: