SHAPE Board Consultation Question Title * 1. What is your Postcode OK Question Title * 2. What is your gender? Female Male OK Question Title * 3. Date of Birth: Date Date OK Question Title * 4. Do you consider yourself to have a disability? Yes No OK Question Title * 5. In the past week, on how many days have you done a total of 30 mins or more of physical activity, which was enough to raise your breathing rate? This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that is part of your job) 1 2 3 4 5+ OK Question Title * 6. Would you like to be more active? OK Question Title * 7. What would motivate you to do this? OK Question Title * 8. Do you have the opportunity to be active? OK Question Title * 9. What activities would you like to do and where? OK Question Title * 10. What barriers, psychological or physical, might you face to being active and how could these be overcome? OK DONE