Lifestyle Survey

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The survey should only take a few minutes to complete but please provide accurate and honest answers.

We use this survey to be able to send you targeted information that we believe could help you lead a healthier lifestyle and get more from your medicines and NHS services.

 

    Your Details

    Measurements

    About You

    Smoking

    Do you smoke or use e-cigarettes?

    How many per day?

    Would you be interested in support to stop smoking?

    Alcohol

    How often do you have a drink containing alcohol?

    How many units of alcohol do you have on a typical day when you are drinking (one unit = half a pint of larger or one single pub measure of spirit or one small glass of wine)?

    How often do you have six or more drinks on one occasion?

    Exercise

    Do you do any exercise/physical activity?

    How much exercise do you do a week?

    Diet

    Do you feel you would benefit from nutrition-related advice from our healthcare team?

    Mental health

    Do you feel you would benefit from some information around mental health from our healthcare team?

    Do you have any additional comments you would like to add?

    Medical Conditions

    Do you have a medical condition that requires regular medication?

    Would you like to provide any further information about your medical condition or medication?