Personal Hygiene Survey Template

It is necessary for you to assess patients and their lifestyle habits before you start taking care of them. A personal hygiene survey gives you an inside look into a patient's daily health habits, so that you can make a better judgement on their treatment. Using the results of this survey, one can also provide patients a better sense of personal care and cleanliness.

Use This Template

Test the Survey


Apart from medical areas, a personal hygiene survey can be useful for those working in social service sector by targeting those responses which indicate less or limited resources.

This template can be customized if there are additional questions you need to address.