Welcome to the 'Get Help to Get Active' service.

The aim of the Get Help to Get Active service is to support inactive adults; I.e. who are doing less than 30 minutes of physical activity and who are living with a long-term health condition to become and stay more physically active.  
We do not provide physical activity.

Question Title

* 1. I agree, that I match the specified criteria stated above.

Question Title

* 2. First Name

Question Title

* 3. Surname

Question Title

* 4. Date of Birth

Date

Question Title

* 5. Postcode

Question Title

* 6. Ethnicty

Question Title

* 7. Have you been diagnosed with any of the following long term health conditions?

Question Title

* 8. Do you consider yourself to have a physical or mental disability that affects your ability to take part in physical activity?

Question Title

* 9. Are you taking any medication?

Question Title

* 10. In the past 7 days, how many minutes of 'MODERATE' physical activity have you taken part in?

Question Title

* 11. How many hours a day would you say you are seated for? (Sedentary)

Question Title

* 12. Please score youself between 1 - 5 (1 being none of the time and 5 being all of the time.)

  1 2 3 4 5
I have been feeling optimistic about the future.
I have been feeling useful.
I have been feeling relaxed.
I have been dealing with problems well.
I have been thinking clearly.
I have been feeling close to others.
I have been able to make up my own mind about things. 

Question Title

* 13. What is the best way of contacting you? (Please leave details)

Question Title

* 14. If you are happy for us to call you to discuss your referral, please leave your details below and when is normally best to contact you, we will attempt to contact you in January 2020.

Question Title

* 15. Are you aware of any activities in your area, either community based or leisure centre based that you are eligible to attend?

Question Title

* 16. Are you interested in our 'FREE HEALTH WALKS BROCHURE'?

Question Title

* 17. If you have any comments or feedback on how best we can support you please let us know. 

Question Title

* 18. Have you had a 'FREE NHS Health Check' in the last 5 years?

0 of 18 answered
 

T