Lifestyle Questionnaire 2025

Name *

First Name

Last Name

Please indicate your activity level at work *

I sit for most of my working day

I sit for most of my working day but always have a lunchtime walk

I sit down occasionally at work and spend the rest of the time on my feet or walking around

I hardly ever sit down at work, my job is an active/physical job

How do you usually travel to/from work? *

Car / bus / get a lift

Cycle

Walk

Other

Are you looking to lose weight? *

Yes

No

Do you smoke? *

Yes

No

How would you describe your levels of stress on a daily basis? *

I feel a moderate level of stress most days

I feel a moderate level of stress sometimes

I generally don't feel stressed, or when I do it's because of a new or challenging situation.

What are your long term or ‘ultimate’ health goals? *

Tick all that apply

Generally feel fitter

Feel stronger / improve strength

Build muscle 'tone'

Increase energy

Feel more positive, better mood

Feel better able to cope with stress

Lose weight

Improve flexibility / mobility

How would you describe your level of motivation to achieve your goals? *

Motivated - I am committed to improving my health and fitness.

Not very motivated - I want to do this, but I do need motivating.

Please indicate the measures you would like to use:

Tick all that apply:

Bodyweight

Body measurements

Before and after pictures

Feedback on how clothes are fitting - perhaps you have a dress or pair of jeans to use as a measure.