Community Mental Health Gyms Check-in

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This form is a check-in that everyone who joins the gym completes. The information that you provide will be used in a couple of ways to help you

Help monitor your progress when you become a member
Suggest things you might want to do

We ask for your email address so we can connect this check-in with previous or future checkins so please use the same email address each time.

We may use this information anonymously to help us work out which areas we need to focus on or to demonstrate positive impact of Community Mental Health Gyms to help us secure funding or grants.

This is based on The World Health Organization-Five Well-Being Index

Email *

Answer these questions based on the last 2 weeks

I have felt cheerful and in good spirits *

5 - All the time

4 - Most of the time

3 - More than half of the time

2 - Less than half of the time

1 - Some of the time

0 - At no time

I have felt calm and relaxed *

5 - All the time

4 - Most of the time

3 - More than half of the time

2 - Less than half of the time

1 - Some of the time

0 - At no time

I have felt active and vigorous *

5 - All the time

4 - Most of the time

3 - More than half of the time

2 - Less than half of the time

1 - Some of the time

0 - At no time

I woke up feeling fresh and rested *

5 - All the time

4 - Most of the time

3 - More than half of the time

2 - Less than half of the time

1 - Some of the time

0 - At no time

My daily life has been filled with things that interest me *

5 - All the time

4 - Most of the time

3 - More than half of the time

2 - Less than half of the time

1 - Some of the time

0 - At no time

A copy of your responses will be emailed to the address you provided.

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