Adult Weight Management & Exercise Referral Survey 2018/19

Page 1 of 3

Closes 31 Jul 2019

Exercise Referral And Adult Weight Management Survey

We are interested in your experience taking part in the Camden exercise referral and adult weight management scheme; please take a few minutes to complete this short survey.

1. Age


2. Gender


3. Ethnicity

4. Are you registered as disabled?


5. How did you hear of us?

6. Which programme did you attend?

7. ONLY answer this question if you attended exercise referral. Which medical condition did your health professional refer you for?

8. Which venue did you attend for majority of your visits?

9. What made you choose this venue?

10. How did you travel and how long was your journey to the venue?

11. Please identify the the instructor you saw most during your referral.

12. How satisfied are you with the Welcome Meeting that took place at the beginning of your referral. (this may have taken place on the telephone).

13. How has the service helped you? (please tick all that apply)

14. How would you rate your satisfaction with the venue (consider facilities, cleanliness and venue staff)?

15. How satisfied are you with the instructor (think about the instructor who supervised your session and take into account; helpfulness, politeness, approachability, professionalism and instructions provided)?

16. How satisfied are you with the overall support you have received from the us throughout your referral ? (follow up telephone calls & texts, discussion on other activities to take part in etc )

17. How satisfied are you with the administration of your referral (taking into account: ease of contact, time between referral and starting activity and paperwork / instructions received)?

18. In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate? 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.

19. Do you have any comments on the service (for example in your view; what we could do better, what do we do well) ?

20. If you would like to be entered into a prize draw to win a £50 gift voucher please complete the following:

Prize draw will take place on 5th Aug 2019

We are unable to respond to individual questions in this survey. Should you require a response to any query or issue please e mail

We will not disclose any of your personal data to other parties or be used for marketing purposes.