Lifestyle Survey

Please fill in as many answers as possible

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

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.

    Contact Details



    Do you smoke?


    How often do you have a drink containing alcohol?


    Do you do any exercise/physical activity?


    Do you eat fruit and/or vegetables?

    Mental health

    Do you feel you have someone to talk to if you have a problem or are in a situation that is worrying or concerning you e.g family,friend, Doctor, colleague)?

    Physical health

    Have you taken part in a national or local campaign in the last year to improve your health (for example: joined one of the on-site fitness classes, enrolled at a gym, walk to work month, Dry January or Stoptober)?

    Have you increased your levels of walking in the last year?

    How do you travel to work?


    Are you aware of opportunities to take part in mindfulness initiatives (For example: mindfulness study days, stress management course, breathing exercise...)?

    Have you taken part in any mindfulness opportunities?

    Medical Conditions

    Do you have a long term, stable medical condition that requires regular medicine in the short to medium term?