Health information questionnaire - 问卷调查调研模板

Q1:About how many people in your city are infected with covid-19

0-10

10-100

100-1000

1000-10000

more than 10000

Q2:Are there any people infected with covid-19 in yourself or your relatives and friends

yes

no

Q3:Does exercise make you happy

yes

no

Q4:Can you observe wearing a mask in public

yes

no

Q5:How many hours do you sleep a day

5hour

6hour

7hour

8hour

more than 9hour

Q6:How long do you exercise in a day

no exercise

10 minutes- 30 minutes

30 minutes-1hour

more than 1hour

Q7:Will your family care about your health

yes

no

Q8:You feel that good health is very important to you

yes

no

Q9:Do you have myopia

yes

no

Q10:How much water do you drink a day

1 cup-2 cup

3 cup-4 cup

5 cup-6 cup

7 cup-8 cup

Q11:Do you eat three meals a day on time

yes

no

Q12:Do you want to keep a healthy body and mind

yes

no

Q13:Do you eat healthily.

always

sometimes

often

never

Q14:Do you think the quality of diet is closely related to health.

yes

no

maybe

unclear

Q15:Do you think the quality of diet is closely related to health.

yes

no

maybe

unclear

Q16:Are you satisfied with this health questionnaire

yes

no

maybe

very satisfied