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YouMove Starting Questionnaire Questions for Marlana Watsica

This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places but should not include housework or physical activity that is part of your job.

0 (not at all happy) – 10 (completely happy)

*

Day
Month
Year

Equality Information

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If yes please could you tell us what type of disability you have? Tick all that apply. *
e.g. due to blindness or partial sight
e.g. due to deafness or partial hearing
such as difficulty walking short distances, climbing stairs, lifting, and carrying objects.
Learning or concentrating or remembering
Mental Health
Stamina or breathing difficulty
e.g. due to neuro diverse conditions such as Autism, Attention Deficit Disorder or Asperger’s Syndrome
Other disability
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