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
Intentional Health
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 feedback@intentionalhealth.uk
Thank you!
PROGRAMME ID *
This will have been sent to the Coach after registering the programme and should be recorded in the front of your handbooks
Your answer
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!
Your answer
Is this questionnaire being completed: *
You will probably only need PRE and POST at the moment!
Required
If after 3 months of programme end date please enter date
MM
/
DD
/
YYYY
When did you first become involved in this activity/start using the service?
(provide a rough date if you are not certain)
MM
/
DD
/
YYYY
Todays Date
THIS SHOULD BE THE DATE ON THE QUESTIONNAIRE - NOT THE DATE YOU ADD THE ANSWERS TO THE SYSTEM!!
MM
/
DD
/
YYYY
Who is filling out this questionnaire?
Please tick one of the below:
Next
Never submit passwords through Google Forms.
This form was created inside of Intentional Health.