This form is for Intentional Health Members Questionnaires.
We really appreciate your time and effort in collecting this data, it will help us continue to evaluate the impact of Intentional Health across the nation! Thank you! :D
IH Programme Questionnaire - Last revised Nov 2017
We would like to invite you to participate in the evaluation of Intentional Health. We want to know if Intentional Health has helped people improve their well-being. Your answers will help us to find out. We can then use this information in the future to help promote Intentional Health to GP’s and commissioning groups so that they can signpost others to the programme.
You do not have to answer the questions if you do not want to. If you cannot answer a question just leave it, and go on to the next question.
We would like to assure you that your responses will remain confidential. If you have any questions about the questionnaire, please ask your coach or contact us at
This will have been sent to the Coach after registering the programme and should be recorded in the front of your handbooks
Enter your 2 digit Member ID
eg 01, 02, 03 etc - One person for each number as assigned on the register. This helps us make sure the pre and post questionnaires are linked to the same person!
Is this questionnaire being completed:
You will probably only need PRE and POST at the moment!
PRE programme - At the start of the project/service?
POST programme - On completion of the project/service?
During /half way through the programme?
At least three months after the end of the project/service? (POST 12 Programme)
If after 3 months of programme end date please enter date
When did you first become involved in this activity/start using the service?
(provide a rough date if you are not certain)
THIS SHOULD BE THE DATE ON THE QUESTIONNAIRE - NOT THE DATE YOU ADD THE ANSWERS TO THE SYSTEM!!
Who is filling out this questionnaire?
Please tick one of the below:
I am filling in the questionnaire about myself
I am a project worker or carer reading out the questions to the participant and filling in their responses.
I am a carer/guardian completing the questionnaire on behalf of someone else (some questions in Section B may be difficult to answer; please just complete as many as you can)
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