Self-Assessment Questionnaire 2023

Move More Live More is aimed at supporting older people to live well for longer. It is a falls prevention programme, which will be tailored to suit a range of individuals’ needs and wants.

This questionnaire aims to understand which variation of the programme may be best suited to your needs and wants. Programme participants may receive information booklets, wearable technology or a 6 week online course, amongst other options.

Following completion of this questionnaire, you may be selected to receive postal information and / or Age NI may contact you by telephone or email to enrol you in further variations of the programme. You are not obligated to commit further and may withdraw at any time.

This programme is for any individual age 65+. It is facilitated by Age NI, in partnership with a consortium including the Southern Health Trust, the Public Health Agency, Ulster University, Big Motive, Taking Care and Technicare. It is funded through the UKRI Innovate UK Healthy Ageing Challenge Fund.

Question Title

* All data collected will be held in a secure database and only used for the purpose of the Move More Live More Programme. All data is held for up to 8 years from the closing date of the record for legal and business purposes. For further information please see our Privacy Policy

Yes, I have read the information and give consent for my data to be used as described

No, I do not consent for my data to be used as described, and do not wish to proceed