Health Questionnaire

BMI

For example, 1.75
For example, 60.6

Smoking

Do you currently smoke?

Do not currently smoke section

Have you smoked in the past?
How many cigarettes did you smoke in a day?

Do currently smoke section

How many cigarettes do you smoke in a day?
Would you like to give up smoking?

Your Blood Pressure

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Exercise

During the last week, how many hours did you spend on each of the following activities?
Physical exercise such as swimming, jogging, aerobics, football, tennis, gym, workout etc:
Cycling, including cycling to work and during leisure time:
Walking, including walking to work, shopping, for pleasure etc:
Housework/childcare:
Gardening/DIY:
How would you describe your walking pace?

Diet

How would you describe your diet?
Do you consume at least 5 portions of fruit and vegetables per day?
Terms and conditions *