lifestyle survery

Lifestyle Survey

A quick lifestyle survey

Please fill in as many answers as possible

The survey should only take a few minutes to complete but please provide accurate and honest answers.

We use this survey to be able to send you targeted information that we believe could help you lead a healthier lifestyle and get more from your medicines and NHS services.




    Do you smoke?

    How many per day?

    Would you be interested in accessing free stop smoking services within your workplace (including free NRT/Champix, behavioural support, carbon dioxide monitoring and resources)?


    How often do you have a drink containing alcohol?

    How many units of alcohol do you have on a typical day when you are drinking (one unit = half a pint of larger or one single pub measure of spirit or one small glass of wine)?

    How often do you have six or more drinks on one occasion?


    Do you do any exercise/physical activity?

    How much exercise do you do a week?


    Do you eat fruit and/or vegetables?

    How many portions do you eat a day?

    Mental health

    Do you feel you have someone to talk to if you have a problem or are in a situation that is worrying or concerning you e.g family,friend, Doctor, colleague)?

    Physical health

    Have you taken part in a national or local campaign in the last year to improve your health (for example: joined one of the on-site fitness classes, enrolled at a gym, walk to work month, Dry January or Stoptober)?

    Would you recommend it to others?

    Have you increased your levels of walking in the last year?

    How do you travel to work?


    Are you aware of opportunities to take part in mindfulness initiatives (For example: mindfulness study days, stress management course, breathing exercise...)?

    Have you taken part in any mindfulness opportunities?

    Can you see how mindfulness is beneficial to overall well being?

    Medical Conditions

    Do you have a long term, stable medical condition that requires regular medicine in the short to medium term?

    Do you require regular medicine in respect of that medical condition?