Healthcare Well-being Survey Template offers questions about the health and well-being of patients who are 55 years and older. This sample can be edited by the survey maker according to the required details about elderly patients. Some of the question examples of this questionnaire are "Overall, how would you rate the local hospitals in your area?", "What about the amount of social support you receive from your family, friends, etc?", "When you have the need to talk to someone or go on outings with friends and/or relatives, do you feel there is someone who fulfills these needs?" et al.