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.
What do you think is good about where you live?
2.
What would make Hertsmere a healthier place to live?
Healthy eating
3.
Do you think you have a healthy diet?
Yes
No
4.
What you help you to improve your diet?
Physical activity
5.
Do you exercise regularly? (30 minutes of moderate exercise a minimum of five times a week?
Yes
No
6.
What would help you to exercise more?
Mental health and wellbeing
7.
Do you feel emotionally well and happy?
Yes
No
8.
What would help you to feel better, more confident and happy?
Healthy lifestyles
9.
Do you smoke?
Yes
No
10.
What would help you to stop or reduce this?
11.
Do you have a drug or substance misuse problem?
Yes
No
12.
What would help you to recover?
13.
What would help you to feel better and become healthier in Hertsmere? Please tick as many as apply from below.
Money advice
Education / training
First Aid
Safety advice
Using parks and outdoor facilities
Physical activities
Volunteering
Meeting people
Keep fit classes
Healthy cooking class
Adult learning
Information
Confidence course
Community projects
Stop smoking sessions
14.
What other things would you like to see available?
15.
Other things you would like to see improved?
16.
Any comments you would like to make about health and wellbeing in Hertsmere?
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:
Male
Female
18.
Age:
15 and under
35 - 49 years old
Over 75 years old
16 - 26 years old
50 - 64 years old
Prefer not to say
25 - 34 years old
65 - 74 years old
19.
Ethnicity:
White
Mixed white and black African
Any other Asian background
White British
Any other mixed background
Black or black British - Caribbean
White Irish
Asian or Asian British - Indian
Black or black British - African
Other white background
Asian or Asian British - Pakistani
Any other black or black British background
Mixed black and Caribbean
Asian or Asian British - Bangladeshi
Chinese
Any other ethnic background - please state:
20.
Do you consider yourself to have a disability?
Yes
No
21.
Employment status
In full time employment
In education or training
Retired
In part-time employment
Unpaid/voluntary work
Self employed
Unemployed
Other, please state:
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.
Mr/Mrs/Miss/other - please state
Name:
Address:
Postcode:
Mobile telephone number:
Home telephone number
Email address:
Thank you for taking the time to complete this survey.