Welcome to Mood Active!

  • We run exercise programs designed to improve your mental health.
  • As a charity our programs are either free or low cost.
  • We ask all participants to complete a registration survey so we can ensure it is safe for you to join our programs. We also ask some questions about your current physical and mental health.
  • The survey takes about 15 minutes to complete and all questions must be answered to secure your spot in the program.

4 Week Wellbeing Workout
In return for our free programs, we ask that you commit to completing a post program survey and 3 month follow survey up. This helps us show our funding partners the effectiveness of the program on your overall wellbeing. All data is stored in a secure database and only shared with authorized personnel including Trainers. Your mood and fitness results with also be shared anonymously with our funding partners and is de-identified (no names) 

The data collected from these surveys is then aggregated to look at patterns and themes and is critical in ensuring that we are able to continue to run our programs.

Casual Program
In return for our low cost programs, we ask that you commit to completing a 3 month follow survey up. This helps us show our funding partners the effectiveness of the program on your overall wellbeing. All data is stored in a secure database and only shared with authorized personnel including Trainers. Your mood and fitness results with also be shared anonymously with our funding partners and is de-identified (no names) 

The data collected from these surveys is then aggregated to look at patterns and themes and is critical in ensuring that we are able to continue to run our programs.

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* Do you acknowledge, understand and agree to the conditions above?

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* If you are under 18, please have your parent or guardian fill in this survey with you and provide their full name, email address and mobile number. 
In doing so, they confirm that-
The information they provide regarding their child’s health is correct, to the best of their knowledge
They will inform the Registered Exercise Professional of any changes to their child’s health immediately
They have been informed and understand the service that is to be provided and give permission for their child to commence the exercise program

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* Which program are you registering for?

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* What is your first and last name?

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* What is your email address

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* What is your phone number?

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* What is your age?

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* Do you identify as a person with a disability?

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* What Council area do you live in?

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* What is your gender?

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* Please provide your emergency contact details

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* Which of the following categories best describes your employment status?

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* Please select the description that best describes your income (before tax)?

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* How did you first find out about Mood Active?

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* If applicable, please include the name of the referrer, directory or other source here:

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* Please provide the details of your Psychologist, Psychiatrist, GP or support person.

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* What are you currently experiencing?

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* Have you received a formal diagnosis?

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* What is your diagnosis (you can select more than one):

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* Are you currently taking a medication for your mental health?

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* In order for us to best understand you and your body, please let us know what medication you are taking and if you have any side effects.

Medication works differently for different people, and it is important for your safety that our trainers can modify exercises for you, if you experience medication side effects.

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* This section has a series of questions about your feelings, emotions and behaviours over this past week.

For each of the statements below, please indicate how often the statement applied to you over the past week

0 = Did not apply to me at all
1 = Applied to me to some degree, or some of the time
2 = Applied to me a considerable part of the time
3 = Applied to me very much, or most of the time

  0 = Did not apply to me at all 1 = Applied to me to some degree, or some of the ti 2 = Applied to me a considerable part of the time 3 = Applied to me very much, or most of the time
I felt like I wasn't much of a person
I experienced trembling (eg. in the hands)
I found myself getting agitated
I found it difficult to work up the initiative to do things
I tended to over-react to situations
I was worried about situations in which I might panic and make a fool of myself
I found I was intolerant of anything that kept me from doing what I was doing
I felt downhearted and blue
I felt I was rather touchy
I felt that life was meaningless
I experienced difficulty breathing(e.g. excessively rapid breathing, in the absence of physical exertion)
I felt that I had nothing to look forward to
I felt that I was using a lot of nervous energy
I felt close to panic
I found it hard to wind down
I was aware of the action of my heart in the absence of physical exertion (e.g. sense of heart rate increase, heart missing a beat)
I was aware of dryness of my mouth
I was unable to become enthusiastic about anything
I found it difficult to relax
I felt scared without any good reason
I couldn't seem to experience any positive feelings at all

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* Coping with stress
Please indicate how true each statement has have been for you during the past week.

0 = not true/rarely true
1 = sometimes true
2 = mostly true/always true

  0 = not true/rarely true 1 = sometimes true 2 = mostly true/always true
I thought I was a failure
My energy level was low
I had difficulty sleeping
I worried excessively
I was not interested in the things I usually enjoy
I wished I was dead
I felt 'on edge'
I got irritated easily
I had a sense of dread or impending doom
My appetite was poor
I had problems concentrating
I felt sad or depressed
I felt anxious
I had difficulty making decisions
I coped well with the normal stresses and hassles of life
I could keep myself from feeling depressed
I was sleeping too much
I had thoughts about killing myself
My appetite was greater than usual
I am able to bounce back from stressful conversations
I felt guilty

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* General Well-Being
Please indicate how true each statement have been for you during the past week.

0 = not true/rarely true
1 = sometimes true
2 = mostly true/always true

  0 = not true/rarely true 1 = sometimes true 2 = mostly true/always true
I was able to fulfill my usual responsibilities
I was engaging in life rather than hiding from it
I was able to have fun
When I woke up I looked forward to the day
I had a general sense of well-being
I cared about things in my life
I was satisfied with life
I felt confident
I was functioning well in my work (e.g. paid job, study or at home)
I felt mentally healthy
I felt in control of my emotions
I woke up feeling fresh and rested
I was participating in social activities
I saw myself as a person of value
I could make decisions without a lot of self-doubt
My life was fullfilling
I felt at ease
I had a positive outlook on life
I had the desire to do things
I could focus and concentrate well

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* Do you have any physical concerns that might prevent you from doing exercise? If you have any concerns please contact your doctor.
To ensure this program is suitable for you, please review the below carefully and check the box if your response is Yes to any of the questions below:

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* Can you give us some more information about any of the items you ticked above? For example, if you are on any medication, can you please list the medication?

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* There are health risks involved with increasing intensity of exercise, especially if you have done no exercise for a long time. This risk is increased if you have answered "Yes" to ANY of the above.

We may seek written approval from your doctor that you are fit to exercise before commencing. Our trainers are not medically qualified to determine if you can or cannot exercise so if you do have any concerns at all, we urge you to seek advice from your medical practitioner.

If you have indicated "Yes" to any of the above, our Program Manager will be in touch to discuss this further.

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* Now think in terms of minutes. Over the course of the week, estimate how many minutes in total you did vigorous exercise.

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* Now think in terms of minutes. Over the course of the week, estimate how many minutes in total you did moderate exercise.

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* Now think in terms of minutes. Over the course of the week, estimate how many minutes in total you walked.

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* Sitting
The last question is about the time you spent sitting on weekdays during the last 7 days. Include time spent at work, at home, while doing course work and during leisure time. This may include time spent sitting at a desk, visiting friends, reading, or sitting or lying down to watch television.

Thinking about an average weekday from the last 7 days...
How many hours did you spend sitting on an average weekday?
Please just give your answer for one day, and not the entire week. If you aren't sure, just make your best guess.

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* What other support are you currently receiving for your mental health?
Please select as many as apply

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* Thank you for taking the time to complete the survey.

You will soon receive a calendar invitation confirming your enrolment. Please ensure you dress in active wear and bring a water bottle. We look forward to meeting you at the first session!

If you have any questions in the meantime, visit our website at www.moodactive.org.au, drop us an email at info@moodactive.org.au or call us on 0412 190 842.

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