PHS Preventative Healthcare Survey - It's all about you...
Please tell us a little about your wellbeing...
How are you feeling? Please score from 1 - 8
Rows
Terrible 1
2
3
4
5
6
7
Excellent 8
Stress levels
Happiness levels
Sleep quality
Friends & family network support
Loneliness levels
Fitness levels
Anxiety levels
Do you feel on top of managing your health and wellbeing?
Yes
No
Other
Are you happy with your health and wellbeing generally?
Yes
No
Other
Do you have a regular issue with any of the following?
Rows
Yes
No
Sometimes
Unsteady on your feet
Back ache
Joint pain
Stiff neck
Tight shoulders
Headaches
Trouble sleeping
Racing heart beat
Menopausal symptons
Panic attacks
Anxiety levels
Low mood / flat
Depression
Negative thoughts
Breathlessness
Bloating / wind
Irritable bowl syndrome (IBS)
Weight loss / fluctuation
Do you take regular prescribed medication?
Yes
No
Please tell us any other symptons / issues that concern you about your health and wellbeing:
Are you happy with your diet?
Yes
No
Other
How often (eg: once a week, every day) do you cook a meal from scratch?
Do you do any of the following?
Rows
YES
NO
SOMETIMES
Relaxation classes / practice
Meditation / mindfulness
Talking therapies
Regularly see a nutritionist
Yoga class
Gym / Fitness class
Running / running club / park runs
Walking (30 mins a day)
Spend time regularly outside in the fresh air on a daily basis
Tell us a little bit about the health and wellbeing activities you do:
What's the average cost of your wellbeing / class / gym membership?
Do you find health and wellbeing activities easily accessible?
Yes
No
If you are employed, does your workplace offer Wellbeing and Health solutions?
Yes
No
Not applicable
Where do you currently go to get health and wellbeing support or advice?
Rows
Please select
GP
Pharmacy
Talking therapies (or similar)
Friends
Family
Work colleagues
Teacher (if applicable)
I don't speak to anyone about it
Other:
What would make it easy for you to access more support to help you to take care of yourself?
What stops you taking care of yourself / wellbeing?
What do you feel is missing?
What are you views about having a wellbeing PHS Hub easily accessible on the High Street?
Would you use it - and why?
What would you want it to offer?
Are 'free classes' important to you - and why?
If you could wave a magic wand and make some changes to your health and wellbeing - what would they look like?
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