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Consumer Survey Form



As a valuable viewer of HealthNet Nepal, your opinion is important to us. So, you are kindly requested to fill up the following one-minute form. Your input will help us to provide you with the health care information/services that matter most to you and your family. Each of your responses will be kept confidential. This survey is for the viewers 18 years of age and over. Thank you.

1.Gender:

Male Female

2. Age:

18-24 25-34 45-54 55-64 65 and over

3. Occupation:

4. Education:

Less Than High School High School Some College

Bachelor Degree Post Graduate Degree

5. Marital Status:

Married Single

6. How many children do you have?:

None 1 2 3 4 5 or more

7. What health and medical topics Interest you most?

(Please, check all that apply):

Education on Medical Conditions Fitness Disease Prevention

Nutrition Detailed Drug Information Drug Interaction Information

Personalized Health Programs Personalized Fitness Program

Interactive Health Quizzes Alternative Medicine Women Health

Men Health Children Health

Email Address:

Comments:

 


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