Health and wellbeing consultation for Hertsmere residents

We would like to find out your views about your health and wellbeing as a resident in Hertsmere and if you feel more could be done to help you improve your lifestyle.

If you have any questions about this survey please contact Community Action Hertsmere at the Community Shop or email: enquiries@communityactionhertsmere.org

For local information please go to: www.communityactionhertsmere.org or www.hertsmere.gov.uk

1.
2.

Healthy eating

3. Do you think you have a healthy diet?
 
 
   
4.

Physical activity

5. Do you exercise regularly? (30 minutes of moderate exercise a minimum of five times a week?
 
 
   
6.

Mental health and wellbeing

7. Do you feel emotionally well and happy?
 
 
   
8.

Healthy lifestyles

9. Do you smoke?
 
 
   
10.
11. Do you have a drug or substance misuse problem?
 
 
   
12.
13. What would help you to feel better and become healthier in Hertsmere? Please tick as many as apply from below.
 
 
 
 
 
 
 
 
 
 
14.
15.
16.

Personal details

Please note this information is confidential and will only be used to show the range of people who have completed this survey.
17. Are you:
 
 
   
18. Age:
 
 
 
 
 
 
   
19. Ethnicity:
 
 
 
 
 
 
 
 
 
 
 
20. Do you consider yourself to have a disability?
 
 
   
21. Employment status
 
 
 
 
   
 
 
   
 

Contact details

If you would like to be kept informed of the results of this survey or other information about activities, events and training opportunities, please provide us with your contact information below.
   
   
   
   
   
   
   

Thank you for taking the time to complete this survey.

 
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