Quick Exit
Skip to content
Facebook
LinkedIn
Twitter
Instagram
We are Restitute
Restitute Conference 19th October – Norwich
About Us
Empowerment
FAQ
Making a complaint
Policies and procedures
Contact Restitute
Help and Support
Complaining about services
Disclosure and criminal justice
Education
Health
Finances
Managing someone else’s affairs
Managing your own affairs
Mental Health
Rest and Respite
The Tough Stuff
Work
Your rights
Support our work
Corporate Partnership
Volunteer
Training and consultation services
Search for:
We are Restitute
Restitute Conference 19th October – Norwich
About Us
Empowerment
FAQ
Making a complaint
Policies and procedures
Contact Restitute
Help and Support
Complaining about services
Disclosure and criminal justice
Education
Health
Finances
Managing someone else’s affairs
Managing your own affairs
Mental Health
Rest and Respite
The Tough Stuff
Work
Your rights
Support our work
Corporate Partnership
Volunteer
Training and consultation services
We are Restitute
Restitute Conference 19th October – Norwich
About Us
Empowerment
FAQ
Making a complaint
Policies and procedures
Contact Restitute
Help and Support
Complaining about services
Disclosure and criminal justice
Education
Health
Finances
Managing someone else’s affairs
Managing your own affairs
Mental Health
Rest and Respite
The Tough Stuff
Work
Your rights
Support our work
Corporate Partnership
Volunteer
Training and consultation services
Search for:
Health assessment
Search for:
Health assessment
admin
2019-11-25T13:55:26+00:00
Health assessment
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Email
*
My physical health is good
Completely true
Somewhat true
Neither true or untrue
Somewhat untrue
Completely untrue
My GP is aware that I am a carer
True
Don't know
False
I have had a health checkup with my GP in the last 12 months
True
Don't know
False
I have had an annual flu jab
True
Don't know
False
I have had my COVID jab(s)
True
Don't know
False
I visited a dentist in the last 12 months
True
Don't know
False
I visited an optician in the last 2 years
True
Don't know
False
I take regular exercise or work in a physically demanding job
Completely true
Somewhat true
Neither true or untrue
Somewhat untrue
Completely untrue
I am happy with my weight
Completely true
Somewhat true
Neither true or untrue
Somewhat untrue
Completely untrue
I have never smoked
True
I used to smoke
I vape
I sometimes smoke
I am a smoker
I don't take recreational drugs
Completely true
Somewhat true
Neither true or untrue
Somewhat untrue
Completely untrue
I don't self-medicate with alcohol or prescription medication
Completely true
Somewhat true
Neither true or untrue
Somewhat untrue
Completely untrue
I don't have a problem with gambling
Completely true
Somewhat true
Neither true or untrue
Somewhat untrue
Completely untrue
I have a healthy relationship with food
Completely true
Somewhat true
Neither true or untrue
Somewhat untrue
Completely untrue
My diet is good
Completely true
Somewhat true
Neither true or untrue
Somewhat untrue
Completely untrue
My blood pressure and cholestrol are within normal bounds
True
Don't know
False
My caring role is not impacting on my physical health
Completely true
Somewhat true
Neither true or untrue
Somewhat untrue
Completely untrue
Is there anything else you want to add?
Website
Submit
Share this:
Twitter
Facebook
LinkedIn
Email
Toggle Sliding Bar Area
Page load link
Go to Top
