POSITIVE VIBES HEALTHY LIVES
This short survey should only take 5-10 minutes of your time to complete. For more info please visit
1. Which of the following activities would you enjoy taking part in if they were available at Whitestone Surgery for young people? (Please tick all that apply)
Arts & Crafts
Health & fitness
None of the above
If you answered 'none of the above' please state why:
2. If Whitestone Surgery offered support groups and activities for young people, would you use them?
Maybe: depends on what it is
3. Do you have any ideas for activities or support groups that Whitestone Surgery could offer for young people?
4. How would you describe the support for young people at Whitestone surgery?
Could be more supportive
Not supportive at all
Unsure of support available
5. How often do you socialise?
A few times a week
Only on the weekends
Not very often
6. If you wanted to socialise more often, what would encourage you to do this?
More free time
Less school/college work
Larger circle of friends
Other (please specify):
7. How often do you feel you are able to communicate with people around you about your worries and stressors? (This may include school/college stress, friendships/family problems etc).
8. Are you Male/Female?
Prefer not to say
9. How old are you?
Thank you for your time. Your voice matters to us and we would like your input to help us develop activities for young people. This short survey is anonymous and the information that you have provided will be used solely for this purpose. If you wish to fill in contact details, please indicate you have the permission from your parent/guardian. You can withdraw your data at any time. For any further information or questions, please contact Keeley at Whitestone Surgery on 024 7664 1911.
Would you be interested in getting involved?
If you would like to be contacted for any further information please enter your details below. If you wish for your response to remain anonymous please leave this section blank.
Parent/Guardian name and contact details (e-mail or phone number):
Parent/Guardian permission to be contacted:
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service