Health & Well-Being 1 Question Title * 1. How many Male & Females in your Household ? Please specify numbers. Male Female Question Title * 2. What age group are the occupants from your household in ? Please specify numbers. 0-5 6-10 11-16 17-18 19-25 26-49 50-64 65-74 75+ Question Title * 3. What area do you live in ? Newbury CCG South Reading CCG North & West Reading CCG Wokingham CCG Other (please specify) Question Title * 4. How would you describe your households ethnic origin ? Please specify numbers. White English/Welsh/Scottish/Northern Irish/British White Irish White Gypsy/Irish Traveller White/Black Carribean White/Black African White/Asian Indian Pakistani Bangladeshi Chinese Black African Black Carribean Other Question Title * 5. How would you describe your households religion ? Please specify numbers. Christianity- Church of England/Catholic/Protestant Buddhism Hinduism Judaism Islam Sikhism No religion I do not wish to disclose Question Title * 6. How would you describe your households sexuality? Please specify numbers. Heterosexual (attracted to the opposite sex) Lesbian/Gay (attracted to the same sex) Bisexual (attracted to both the opposite sex and the same sex) I do not wish to disclose this Question Title * 7. How many people in your household could be described as the following. Please specify numbers Looked after children People on low incomes Lone parents Adults in care Unemployed people Carers People in housing need Asylum Seekers/ Refugees People with mental health needs People with learning disabilities/ difficulties People with physical / sensory disabilities People with other disabilities People recovering from addiction Excluded or in danger of exclusion from school Ex-offenders/ at risk of offending Question Title * 8. How often do the adults in your household visit your GP ? Monthly 6 Monthly Yearly As required or advised Other (please specify) Question Title * 9. How often do the children/adult dependents in your household visit your GP ? Monthly 6 Monthly Yearly As required or advised Other (please specify) Question Title * 10. How often do the adults in your household have hospital/specialists appointments ? Monthly 6 Monthly Yearly As required or advised Other (please specify) Question Title * 11. How often do the children/adult dependents in your household have hospital/specialists appointments ? Monthly 6 Monthly Yearly As required or advised Other (please specify) Question Title * 12. How often do the adults in your household visit the dentist ? Monthly 6 Monthly Yearly As required or advised Other (please specify) Question Title * 13. How often do the children/adult dependents in your household visit the dentist ? Monthly 6 Monthly Yearly As required or advised Other (please specify) Question Title * 14. How often do the adults in your household visit the hygenist ? Monthly 6 Monthly Yearly As required or advised Other (please specify) Question Title * 15. How often do the children/adult dependents in your household visit the hygenist ? Monthly 6 Monthly Yearly As required or advised Other (please specify) Question Title * 16. How often do the adults in your household visit the opticians ? Monthly 6 Monthly Yearly As required or advised Other (please specify) Question Title * 17. How often do the children/adult dependents in your household visit the opticians ? Monthly 6 Monthly Yearly As required or advised Other (please specify) Question Title * 18. Which of the following weight group are the adults in your household in ? Low weight Average weight Over weight Obese Severely Obese Other (please specify) Question Title * 19. Which of the following weight group are the children/adult dependents in your household in ? Low weight Average weight Over weight Obese Severely Obese Other (please specify) Question Title * 20. What food types do the adults in your household consume ? Meat/Fish Fruit/Veg Pre-packed Ready Meals Restricted Other (please specify) Question Title * 21. What food types do the children/adult dependents in your household consume ? Meat/Fish Fruit/Veg Pre-packed Ready Meals Restricted Other (please specify) Question Title * 22. What other food types do the adults in your household consume ? Fizzy Drinks Chocolate Biscuits Alcohol Tobacco Other (please specify) Question Title * 23. What other food types do the children/adult dependents in your household consume ? Fizzy Drinks Chocolate Biscuits Alcohol Tobacco Other (please specify) Question Title * 24. How long do the adults in your household exercise for per day ? 0-30 mins 30 mins - 1 hour 1-2 hours 2-4 hours No exercise Other (please specify) Question Title * 25. How long do the children/adult dependents in your household exercise for per day ? 0-30 mins 30 mins - 1 hour 1-2 hours 2-4 hours No exercise Other (please specify) Question Title * 26. What type of exercise do the adults in your household do ? Question Title * 27. What type of exercise do the children/adult dependents in your household do ? Question Title * 28. Do any of the adults in your household access community activities ? Yes No Question Title * 29. Do any of the children/adult dependents in your household access community activities ? Yes No Question Title * 30. Do any of the adults in your household access any of these support organisations ? Group Support Meetings Social Events Training Other (please specify) Question Title * 31. Do any of the children/adult dependents in your household access any of these support organisations ? Group Support Meetings Social Events Training Other (please specify) Question Title * 32. How do the adults in your household access these support organisations ? Internet E-mail Web Support Other (please specify) Question Title * 33. How do the children/adult dependents in your household access these support organisations ? Internet E-mail Web Support Other (please specify) Done