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Active 3x30 Activity Survey

In order that we can track whether our programme is helping you become more physically active, please could you answer a few questions....

First Names
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Surname
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Address
Postcode
Email
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How many times per week on average would you say you were participating in moderate physical activity 3 to 6 months ago?
How many times per week on average would you say you have participated in moderate physical activity over the last 4 weeks?
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What sort of moderate physical activity have you been undertaking during the last 12 weeks? Hold down Ctrl tab on your keyboard to select mutiple options. Please list any additional activities below
Other activities
Check the box if you have taken up any new physical activities or sports during the last 12 weeks?
If yes, please name at least one
Date Completed DD/MM/YYYY e.g 22/05/2009
required field
required field = Required

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