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Questionnaire for health and wellness

questionnaire for health and wellness

1. Which age group do you belong to?
3. Which occupational category would you fall under?
4. What is your average annual income level?
5. Which techonological devices do you use regularly / are comfortable using? (tick all that apply)

6. Are you concerned with your health / wellbeing on a regular basis e.g. using the internet to search for health / medical information, reading the health section in newspapers / magazines, taking vitamins and supplements etc?
7. How much do you spend on average per month on: Vitamins / Dietary Supplements; Gym Membership; Excercise Classes; Any other promoting wellness products (preventative health measures)
8. Specifically how much do you usually spend on vitamins / diet supplements per month?
9. Are you a member of a gym / fitness program OR do you excercise regularly?
10. How many times on average do you visit your GP per year?
11. On a scale of 1 to 5 how do you rate your overall health? 1 = Poor, 5 = Excellent
12. What are the main reasons that you visit your GP? (tick all that apply)

13. Which, if any, of these conditions do you suffer from? (tick all that apply)

14. Which, if any of these, conditons are you concerned about (either due to family history, lifestyle, previous experience etc)? Please tick all that apply

15. Do you currently use any health monitoring device(s) e.g. blood glucose monitor, blood pressure monitor etc?
16. Would you consider purchasing a device that monitors various aspects of health and wellbeing on a regular basis?
e.g. one device that monitors BP, Cholesterol, Blood Glucose etc
17. How much would you be willing to spend on a portable, "all-in-one" device that monitors Blood Pressure, Cholesterol and Blood Glucose to give early indicators and help in the control of heart disease / stroke?
18. How much would you be willing to spend on a portable, "all-in-one" device that could monitor your body for unusual moles/lumps e.g. to detect possible early stages of cancer?
19. How much would you be willing to spend on a portable, "all-in-one" device that monitors your body for early signs of infections (e.g. Chronic Pulmonary Disease, Bacterial Infection)?

20. If you would like to be entered into our prize draw for a £100 Marks & Spencer voucher then please enter your e-mail address below. The winner will be notified by e-mail within the next two weeks.

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