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MOTIVATE Sefton- Post Programme
Welcome to the MOTIVATE Sefton Questionnaires. These questionnaires should take you less than 30 minutes to complete.
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* Indicates required question
What is your name?
*
Your answer
What is your date of birth?
MM
/
DD
/
YYYY
Please list any medical conditions and associated medications:
Your answer
The next few questions are from your health check that you have just completed. Please have your check list ready to copy your results.
What is your height (cm)?
Your answer
What is your weight (kg)?
Your answer
What is your waist circumference #1?
Your answer
What is your waist circumference #2?
Your answer
What is your waist circumference #3?
Your answer
What is your Systolic blood pressure #1 (Top Number)?
Your answer
What is your Diastolic blood pressure #1 (Bottom Number)?
Your answer
What is your Systolic blood pressure #2 (Top Number)?
Your answer
What is your Diastolic blood pressure #2 (Bottom Number)?
Your answer
What is your Systolic blood pressure #3 (Top Number)?
Your answer
What is your Diastolic blood pressure #3 (Bottom Number)?
Your answer
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