The prevention check-up questionnaire is a self-assessment questionnaire specific to each age group (18-25, 45-50, 60-65, 70-75), to be filled in before the appointment, in Mon espace santé (France’s personal digital health record) or as a PDF on ameli.fr, the website of French National Health Insurance (Assurance Maladie). It does not score anything: it helps identify your habits and risks so that you and the professional can choose one or two priority topics.
What is the prevention check-up questionnaire?
The prevention check-up questionnaire, officially called the “self-assessment questionnaire” (autoquestionnaire), is the first of the three steps of Mon bilan prévention, France’s national prevention check-up program: identifying your individual risks. It comes in four versions, one per age group (18-25, 45-50, 60-65 and 70-75 inclusive), and you fill it in before the appointment, at home, at your own pace.
It is neither an exam nor a graded test. Its questions cover your lifestyle and situation: diet, physical activity and sedentary behavior, smoking, alcohol and other addictions, sleep, mental health and well-being, sexual health, cancer screening, vaccination, prevention of cardiovascular disease and, depending on age, menopause, aging or isolation. These are the topics the program lists as ones that may be discussed during the check-up.
It serves two purposes. For you, it makes you take stock, something we almost never do on our own: when was your last screening, how many drinks a week, are you sleeping enough, is anything worrying you. For the professional, it helps prepare a 30- to 45-minute consultation that gets straight to the point instead of covering everything. It is also what makes the second step possible, prioritizing one or two topics, and then the third, writing the Personalized Prevention Plan.
Where can I find the Ameli prevention check-up questionnaire?
The prevention check-up questionnaire is available in three places: online in Mon espace santé (monespacesante.fr), as a PDF for each age group on ameli.fr and sante.fr, and on paper from the professional who carries out the check-up. All three versions have the same content; choose whichever is easiest for you.
| Where | Format | For whom | Advantage |
|---|---|---|---|
| Mon espace santé (monespacesante.fr) | Online questionnaire, linked to your record | Anyone who has activated their account | Your answers are saved and can be shared with the professional |
| ameli.fr and sante.fr | PDF to download or print, one per age group | Anyone, no account needed | Filled in with a pen, easy to slip into your bag on the day of the appointment |
| At the professional’s (office, pharmacy) | Paper version handed out on site | People who could not fill it in beforehand | Filled in together at the start of the appointment |
For ages 60-65, for example, sante.fr has a page dedicated to that age group’s self-assessment questionnaire, with the document to download; the ameli “Mon bilan prévention” pages for each age group each link to the corresponding questionnaire. Make sure you take the version for your age: the questions are not the same.
Do I have to activate Mon espace santé?
No. The PDF is enough, and the professional can give you a paper copy. Mon espace santé is, however, useful beyond the questionnaire: it is one of the channels through which the Personalized Prevention Plan can be sent to your regular doctor (médecin traitant), and it lets you find your documents and vaccination record later on.
What does the self-assessment questionnaire cover at each age?
Each age group has its own questionnaire, because prevention priorities are not the same at 20, 47, 62 or 73. We do not reproduce the official questions here; below are the topics each version emphasizes, as generally recognized.
| Age group | Topics emphasized |
|---|---|
| 18-25 | Mental health and well-being, addictions (tobacco, alcohol, cannabis, screens), sexual health and contraception, vaccinations and catch-up doses, sleep, diet and physical activity, registering a regular doctor |
| 45-50 | Cardiovascular risk, type 2 diabetes, organized cancer screening programs, smoking and alcohol, physical activity, menopause and perimenopause, mental health and work-related stress |
| 60-65 | Continued cancer screening, cardiovascular risk, vaccinations, osteoporosis, hearing and vision, physical activity, preparing for retirement and isolation |
| 70-75 | Fall prevention, undernutrition, cognitive function, hearing and vision, vaccinations, medication review, isolation, physical activity, caregivers |
The age-specific articles cover each of these topics in detail: the prevention check-up at 18-25, at 45-50, at 60-65 and at 70-75.
One thing all four versions have in common: the questionnaire also asks what you would like to discuss and what you feel ready to change. Those are the most important questions, because the check-up is about your priorities, not a standard list.
How do you fill in the questionnaire honestly?
The prevention check-up questionnaire is only useful if it is honest; an embellished questionnaire produces a plan that has nothing to do with you. In consultations, we see three common biases, and three ways to avoid them.
- The good-student bias. People round their smoking down, their physical activity up, and their drinking to “occasionally.” Base your answers on a real week, the last one, not an ideal week. No one will judge you: the professional has seen every possible answer, and a true answer is the only one that allows action.
- The memory bias. “My last Pap smear? Recently.” Check: Mon espace santé, your reimbursement statements, your vaccination record. An exact date is better than an impression.
- The modesty bias. Sleep, mood, sexuality, alcohol, violence, loneliness: these are often the topics people skip, and the ones where the check-up can help the most. If writing about them is hard, at least check “I would like to talk about it”; the appointment is confidential, including at the pharmacy, where a private consultation area is mandatory.
A few practical tips: fill it in a few days ahead, not in the waiting room; allow about ten minutes; keep your prescriptions and vaccination record at hand; and if you are helping an older parent, help them answer without answering for them.
What happens to the questionnaire during the appointment?
During the check-up, the questionnaire serves as a guide: the professional goes through it with you, stops on what stands out, and fills in a risk-screening support form, the official tool that structures their review. The appointment lasts 30 to 45 minutes; the aim is not to cover everything.
Next comes the second step: choosing one or two priority topics together. This choice is as much yours as the professional’s; a topic you are not ready to discuss is not a good priority, even if it matters medically. Then the third step: writing the Personalized Prevention Plan, with your priorities, your obstacles, concrete actions, resources and follow-up.
At the end, the plan and the risk-screening support form are sent to your regular doctor, unless you object, by secure messaging, via Mon espace santé or by you. The questionnaire itself belongs to you: keep it, it will serve as a point of comparison at the next check-up.
Is there an online version of the prevention check-up questionnaire?
Yes, two, and they play different roles. The official online version is the one in Mon espace santé: it is the program’s self-assessment questionnaire, linked to your record. Alongside it, the Sokrate service offers an adaptive online preparation questionnaire that covers nine dimensions of your health and habits to put together a file before the consultation.
The Sokrate questionnaire replaces neither the official self-assessment questionnaire nor the appointment: the prevention check-up is a consultation with a health professional, fully covered (100%) by French National Health Insurance, and that consultation is what leads to the personalized plan. It complements it by going into more detail on your risk factors and what motivates you, and by preparing a document that the doctor validates, adjusts and signs. We describe it in how it works. If your professional works with Sokrate, the two come together; if not, the preparation questionnaire simply helps you arrive better prepared.
Key takeaways
- The prevention check-up questionnaire is an official self-assessment questionnaire, specific to each age group (18-25, 45-50, 60-65, 70-75), to be filled in before the appointment.
- It is available online in Mon espace santé, as a PDF on ameli.fr and sante.fr, or on paper from the professional.
- It does not score or diagnose anything: it helps identify your habits and choose one or two priority topics.
- Fill it in honestly, a few days ahead, with your prescriptions and vaccination record at hand.
- The personalized plan that results from it is sent to your regular doctor, unless you object.
What Sokrate lets you do
The Sokrate service offers an online preparation questionnaire, complementary to the official self-assessment questionnaire, to identify your risk factors and priorities before the consultation. The personalized plan is then signed by a doctor, a letter is sent to your regular doctor unless you object, and a coordinating nurse handles follow-up. You can start your preparation questionnaire right now.