Health Walks Questionnaire

Approx time to complete: 6 mins 30 secs

Please read the questions carefully and answer as fully as possible.

A. Participant Details

Please enter your postcode below, click 'Search for an address' and then select the correct address from the dropdown.

Emergency Contact Details

Name and telephone number of someone who can be contacted in an emergency:

B. Health Information

C. About You

*moderate activity where you feel warmer and breathe more deeply. Activities can include walking, cycling, gardening, sports, DIY and housework. Exercise can be built up of 10 minute bursts and doesn't have to be all done at once.

To help us ensure that we are providing our services equally to all members of our community we would like to know which of these best describes you. The information you give is confidential and will be used for monitoring purposes only.

Declaration