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Wellness Questionnaire

Prioritise your health and complete the wellness questionnaire now. Once completed, you’ll receive a health report giving you a clearer picture of your health.

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Submit

Over the last two weeks, have you been bothered by any of the following problems?
Little interest or pleasure in doing things
Feeling down, depressed or hopeless
Over the last two weeks, have you been bothered by any of the following problems?
Felt nervous or on edge
Not being able to stop or control worrying
Has your father, brother or son had coronary heart disease or stroke before age 55?
Has your mother, sister or daughter had coronary heart disease or stroke before age 65?
Have you been diagnosed with heart disease?
Have you been diagnosed with high blood pressure?
Do you take medication for high blood pressure?
Do you take medication for high cholesterol?
Have any of your immediate family members been diagnosed with diabetes? (parent, brother, sister, child)
Have you been diagnosed with diabetes?
Do you take diabetes medication?
Have any of your other family members been diagnosed with diabetes? (grandparent, aunt, uncle, cousin)
Do you take any chronic medication?
Are you registered on a scheme chronic management programme?
Do you know your HIV status?
Do you smoke?
Do you perform 30 minutes of physical activity at least 5 days a week?
Do you eat fruit, vegetables or berries daily?
How many alcoholic drinks do you consume per week?
How would you rate your health?
How motivated are you to improve your lifestyle?
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