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What's your name?

Information: These questions are private and confidential, your data will not be shared with anyone. We use this information to determine your health score and assess your risk to certain health conditions. We ask you to please answer as honestly as you can.

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What's your date of birth?

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What sex were you assigned at birth?


Have you ever taken the oral contraceptive pill?


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What’s your height?

cm

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What do you currently weigh?

kg

Ibs

Information: We use your weight and height to calculate your body mass index (BMI). Being overweight for your height is a risk factor to certain chronic health conditions such as heart disease.

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What ethnicity best describes you?

Select your ethnic subgroup






Select your ethnic subgroup




Select your ethnic subgroup





Select your ethnic subgroup


Select your ethnic subgroup


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Has anyone in your family been diagnosed with…







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Have you been diagnosed with any of the following…











Do you currently have any form of cancer?



What type of diabetes do you have?



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What is your systolic (higher value) blood pressure?

What is your diastolic blood pressure?

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What is your smoking status?


Information: This question is related to tobacco smoking and understanding your current smoking status.

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How many hours of sleep do typically get in every 24 hours? (Please include naps)


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In the last 2 weeks, how often have you been affected by trouble falling asleep, staying asleep or sleeping too much?


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How many minutes of moderate intensity activity do you generally carry out each week?


Information: Moderate intensity activity includes any activity that raises your heart rate, makes you breathe faster and feel warmer. One way to tell if you are exercising at a moderate intensity level is if you can still talk but not sing. Examples of moderate intensity activities are; brisk walking, riding a bike, dancing, hiking, and gardening

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How many minutes of vigorous intensity activity do you generally carry out each week?


Information: Vigorous intensity activity makes you breathe hard and faster. If you are exercising at this intensity, you will not be able to say more than a few words without pausing for breath. All moderate activities can become vigorous intensity if you can increase the effort level. Examples of vigorous activities are jogging or running, swimming fast, riding a bike fast or up hills, playing sports like football, rugby, netball & hockey, skipping rope, and martial arts.

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Are you a…


How often do you eat processed meats? (e.g. bacon, ham, sausages, meat pies, kebabs, burgers, chicken nuggets)


How often do you eat oily fish? (e.g. sardines, salmon, mackerel, herring)


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How many pieces of fresh fruit do you eat per day?


Information: One piece of fruit is either one whole fruit like an apple, orange, pear or banana. Other examples of what counts as a piece of fresh fruit is: two plums, six lychees, three apricots, 14 cherries or 7 strawberries. For dried fruits 30g would be one portion of fruit.

How many servings of raw vegetable pieces do you eat per day?


Information: A portion of salad vegetables include 1.5 full length celery sticks, 5 cm piece of cucumber, 1 medium tomato or 7 cherry tomatoes.

How many servings of cooked vegetable pieces do you eat per day?


Information: A portion would be 2 broccoli spears, 4 heaped tablespoons of cooked kale, spinach, spring greens or green beans. For cooked vegetables, a portion is 3 heaped tablespoons of cooked vegetables, such as carrots, peas or sweetcorn, or 8 cauliflower florets.

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How often do you have a drink containing alcohol?


How many drinks containing alcohol do you have on a typical day when you are drinking?


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How many glasses (200 mls) of water do you drink each day?

glasses

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In general how happy are you with your health?









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Are there any areas you would like to make improvements on?










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Information: These questions are private and confidential, your data will not be shared with anyone. We use this information to determine your health score and assess your risk to certain health conditions. We ask you to please answer as honestly as you can.

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