Clone of Physical activity

  • Physical activity

  • This questionnaire is designed to measure your ability to carry out daily activities. Your answers give us important information on your current physical activity level that can guide your prehabilitation appropriately. For each question, please answer "Yes" if you can perform the activity, otherwise answer "No”.

  • Can you:

    • Scores 

    • This questionnaire results in two scores that you can share with your health professional:

    • End 

    • Thank you for completing the physical activity questionnaire.

      Please make a note of your two scores to share with your health professional.

      If you provided an email address at the start you will receive an email from 'Jotform' with a pdf of your results attached after you click the submit button below. 

      Your next steps:

      • Visit the national prehabilitation website or scan the QR code below to access 

      • Attend a universal prehabilitation workshop at your local Maggie’s Centre or equivalent local organisation.

      Your medical team may ask you to repeat this questionnaire in the future to see if there has been a change in your physical activity level. If you notice a change in your physical activity level or general health after completing the questionnaire please contact your medical team for advice.

    • Thank you for completing the physical activity questionnaire.

      Please make a note of your two scores to share with your healthcare team as instructed. Your healthcare team may contact you to discuss your score in more detail.

      If you provided an email address at the start you will receive an email from 'Jotform' with a pdf of your results attached after you click the submit button below.

      Your next steps:

      • Visit the national prehabilitation website or scan the QR code below to access 

      • Attend a universal prehabilitation workshop at your local Maggie’s Centre or equivalent local organisation.

      Your medical team may ask you to repeat this questionnaire in the future to see if there has been a change in your physical activity level. If you notice a change in your physical activity level or general health after completing the questionnaire please contact your medical team for advice.

    • Thank you for completing the physical activity questionnaire.

      Please make a note of your two scores to share with your healthcare team as instructed. Your healthcare team may contact you to discuss your score in more detail.

      If you provided an email address at the start you will receive an email from 'Jotform' with a pdf of your results attached after you click the submit button below.

      Your next steps:

      • Visit the national prehabilitation website or scan the QR code below to access 

      • Attend a universal prehabilitation workshop at your local Maggie’s Centre or equivalent local organisation.

      Your medical team may ask you to repeat this questionnaire in the future to see if there has been a change in your physical activity level. If you notice a change in your physical activity level or general health after completing the questionnaire please contact your medical team for advice.

    • Should be Empty: