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Health and Fitness Assessment - Post-engagement
1.
Overall Physical Health
- How would you rate your overall physical health?
Excellent
Very Good
Good
Poor
Very Poor
2.
Physical Activity Level
- How often do you engage in physical exercise or activities (e.g., walking, running, sports)?
Daily
Several times a week
Once a week
Rarely
Never
3.
Diet and Nutrition
- How would you describe your diet and nutrition?
Very healthy
Somewhat healthy
Neutral
Somewhat unhealthy
Very unhealthy
4.
Access to Healthcare
- Do you have access to necessary healthcare services (e.g., doctors, medication, treatments)?
Yes
No
Not sure
5.
Chronic Conditions -
Do you have any chronic health conditions (e.g., diabetes, hypertension) that require ongoing management?
Yes
No
Not sure
6.
Mental Health -
How often do you feel mentally well (e.g., free from anxiety, depression, stress)?
Always
Most of the time
Sometimes
Rarely
Never
7.
Sleep Quality -
How would you rate the quality of your sleep?
Excellent
Good
Fair
Poor
Very Poor
8.
Substance Use -
Do you use tobacco, alcohol, or other substances?
Never
Rarely
Occasionally
Often
Always
9.
Health Education -
How well-informed do you feel about maintaining a healthy lifestyle (e.g., nutrition, exercise, hygiene)?
Very well-informed
Somewhat informed
Neutral
Somewhat uninformed
Very uninformed
*
10.
Please write your name, phone number and email address below. (We will not pass your details to any third parties.)
(Required.)