Men Health Needs Assessment Survey

The Men Health Needs Assessment Survey is a tool used to assess the health needs of men. It is a self-administered questionnaire that asks questions about health problems, health care access, and health-related behaviors. The survey is designed to help identify areas where men may need more education or services to improve their health.

Time to complete

2 minutes

Eligibility

Men 18 years of age and older are eligible to fill out this survey.

Not the Template you are looking for?
Request new template
Not the Template you are looking for?
Request new template

Questions for Men Health Needs Assessment Survey

1.

Do you have any health concerns that you would like to discuss with a healthcare provider?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
2.

Have you ever been diagnosed with any chronic health conditions?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
3.

Do you have regular health checkups?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
4.

Do you eat a balanced and healthy diet?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
5.

Do you get enough exercise?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
6.

Do you use tobacco products?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
7.

Do you drink alcohol?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
8.

Do you use drugs?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
9.

Do you have any mental health concerns that you would like to discuss with a healthcare provider?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
10.

Do you have access to healthcare?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
11.

Do you have health insurance?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
12.

Do you have a regular doctor or healthcare provider that you see for your health needs?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
13.

Do you feel like you are able to talk openly with your healthcare provider about your health needs?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
14.

Do you feel like your healthcare needs are being met?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
15.

Is there anything else you would like to share about your health or healthcare experiences?

The answer should be a text input.

Similar Ideas

  • Women's Health Needs Assessment Survey
  • Senior Health Needs Assessment Survey
  • Children's Health Needs Assessment Survey
  • Community Health Needs Assessment Survey

Here are some FAQs and additional information
on
Men Health Needs Assessment Survey

What is the purpose of this survey?

The purpose of this survey is to help assess the health needs of men. The survey will collect information on men's health habits, behaviors, and needs in order to help design programs and services that better meet the needs of men.

Who is the target audience for this survey?

The target audience for this survey is men aged 18 and over.

How will the survey be used?

The survey will be used to collect data on men's health habits, behaviors, and needs. This data will be used to help design programs and services that better meet the needs of men.

How long will the survey take to complete?

The survey should take no more than 10 minutes to complete.

Is the survey confidential?

Yes, the survey is confidential. All of the information you provide will be kept strictly confidential.

Will I be compensated for taking the survey?

No, you will not be compensated for taking the survey.

Want to use this template?

Loved by people at home
and at work

“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Dapp.com
Editor's choice
BlockSurvey social proof
Capterra
4.9 Star Rating

What's next? Try out templates like
Men Health Needs Assessment Survey

1000+ Templates, 50+ Integrations

Want to create secure online forms and surveys?

Join BlockSurvey.

SHARE