Kirklees Healthy Lifestyle Survey
In Kirklees we want people to live longer, healthier, happier lives and feel more able to look after themselves and others. We’d like to know your views on what affects your physical, mental, social and emotional health. The information you give will help us shape what approach we take to help improve health in the future and will influence what services are provided.
This survey will ask you about:
1. Your health and wellbeing
2. Your barriers/motivations towards leading a healthy life
3. Your views on what services are available to help you lead a healthy life
4. Finally some questions about you
This survey will take about 10 minutes to complete.
Part 1 - In relation to your health and wellbeing….
How is your health in general? Would you say it is..
Do you currently have any physical or mental health conditions which have lasted or are expected to last 12 months or more?
Which, if any, of the following health conditions or illnesses do you have or have you had in the last 12 months? Please tick all that apply.
Other mental health condition
Asthma (using an inhaler)
Chronic pulmonary (lung) disease (e.g. emphysema, chronic bronchitis)
High blood pressure
Short-term pain (lasting less than 3 months) not including backache
Long-term pain (lasting more than 3 months) not including backache
Sciatica, lumbago or recurring backache
Neuromuscular condition (e.g. Parkinson’s, MS, epilepsy)
Musculoskeletal / rheumatological problems (e.g. arthritis, tendinitis)
Dermatological problems (e.g. psoriasis, eczema)
Continence problems (leakage of your bladder or bowel)
Please list other conditions below: