Lifestyle Survey

Height (cm or ft)

Weight (kg)

Age

Gender

Do You Smoke?

How often do you have a drink containing alcohol?

Do you Exercise Regularly?

Does your diet include fruits and vegetables?

If you feel worried or anxious about something, do you have someone to talk to such as a friend, family or a mental health professional?

What do you think would help you lead a more healthy and balanced lifestyle? Please share any points.

Have you taken part in any local or national health campaigns in the last 12 months such as dry January or Stoptober?

In the last 12 months, have you increased the amount of walking you do?

How do you commute to work?

Are you aware of any local or national mindfulness activities such as educational days or mindfulness group activities?

In the last 12 months, have you taken part in any local or national mindfulness activity?

Do you take regular medication for any long-term medical condition?