Rehab Management's Lifestyle Assessment.

How many minutes of moderate activity or exercise do you do per week (involve effort, but you can still talk)?*

How many minutes of strenuous physical activity per week (make you breathe harder and faster)?*

Do you have trouble falling asleep at night?*

Not at allOccasionally2 - 3 nights per weekVery often

Do you wake in the night and have difficulty going back to sleep?*

Not at allOccasionally2 - 3 nights per weekVery often

How many hours on average do you sleep each night?*

How close to bedtime is your last tea/coffee/cola/ other caffeine drink?*

How many standard caffeinated drinks do you have a day?*

How do you feel you are coping with the pressures of work?*

How do you feel you are coping with the pressures of home life?*

How do you consider your current state of mental and physical health?*

Do you experience sudden feelings of anxiety?*

Very oftenQuite oftenNot very oftenNot at all

Do you currently feel under financial pressure?*

A great dealQuite a lotAverageNot at all

How much support do you receive from colleagues or people around you in the day?*

How much support do you receive from friends and family?*

Do work issues and needs intrude on your home life?*

Retest

Yes

Awareness. Do you believe your awareness of your health and wellbeing has improved as a result of this program?*

YesNo

Action. Have you taken action to improve your heath and wellbeing as a result of this program?*

YesNo

Future. Do you feel more confident to self manage your health and wellbeing in the future as a result of your participation in this program?*

YesNo

On a scale of 0-10 what is the likelihood of recommending Rehab Management to a friend or a colleague?*