Recall Questionnaire

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Personal Details

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Ethnicity, Height & Weight

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Average Blood Pressure

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Smoking & Alcohol

For Reference:

Beer

1 pint (568ml) of 4% beer or lager ≈ 2.3 units

Wine

175ml glass of 12% wine ≈ 2.1 units

Spirits

25ml shot of 40% spirit ≈ 1 unit

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Exercise

Physical Activity at Work: *

Physical Exercise: *

During the last week, how many hours did you spend on each of the following activities?

Physical exercise such as swimming, jogging, aerobics, football, tennis, gym workout etc: *

Cycling, including cycling to work and during leisure time: *

Walking, including walking to work, shopping, for pleasure etc: *

Housework/Childcare: *

Gardening/DIY: *

Physical Activity at Work: *

How would you describe your usual walking pace?

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Diet

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Recall Questionnaire

For Reference:

Beer

Wine

Spirits

Physical Activity at Work: *

Physical Exercise: *

Physical Activity at Work: *

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