Physical activity questionnaire

This easy to use patient questionnaire has been validated for use in Primary Care.

About the form

Fields marked with an asterisk (*) are compulsory.

Thank you for agreeing to complete this questionnaire. Please fill in all of the appropriate fields and click ‘Send’.

Physical Activity Questionnaire

  • Your details:

  • Questionnaire:

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

    Please answer whether you are in employment or not
  • Your Walking Pace


By using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your information.

Personal Information

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.