Denver D.

Reamico BSA Types of Questionnaires

Open-ended question:
During sickness, what do you do first?
_____________________________________________________________________________
_____________________________________________________________________________
__________________________________________________________________________
Close-ended question
a. Recall type:
Please supply the information asked for.
Name:_______________________________________________ Age:________ Sex:_________
Date of birth:_____________________ Place of birth: _________________________________
b. Recognition type:
1. Dichotomous type:
Please put a check before your reply.
Have you ever been confined in a hospital because of sickness?

__Yes __ No

Are you a member of a medical service provider company? (e.g. PhilHealth) __Yes __No
2. Multiple choice:
What is your highest educational background? Please put a check mark before your reply.
____Elementary graduate
____High school graduate
____College graduate
3, Multiple response:
What type(s) of medicine do you take? Place check marks before your choices.
___syrup
___tablet
___capsule

___suspension