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Health Survey

Get health information of people with this online survey and create a huge database.

1
Personal Data
Please Select
Please Select
Male
Female
Gender
Age
Height (inches)
Weight (lbs)
2
Do you smoke?
YESNO
3
How many packs per day do you consume?
Less than 1 pack/day
1 Pack/day
2 Packs/day
3+ Packs/day
4
Since what age did you started smoking?
5
Do you do any exercise?
YESNO
6
How many times in a week do you exercise?
1 - 3 a week
3 - 5 a week
Everyday
7
How many hours do you sleep in a day?
Less than 5 hours
5 - 6 hours
7 - 8 hours
9 - 10 hours
More than 10 hours
Should be Empty:

Question Label

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