Penny for your thoughts…

Consent*

We are committed to protecting your data and any information you share will be kept private, confidential and anonymous. If you would like to see our data protection policies, you can view them online at www.moveitorloseitclub.co.uk. Please indicate your consent to share this information with us by ticking the box below:

I consent to provide Move it or Lose it with the required information.

General

Please tell us your email address:*

Please tell us the type of accomodation you live in

This will help us understand more about the audience that engages with The Club.

In my own home (private/rented)
In my own home (retirement village/assisted living)
In a care home

Use of The Club

We'd love to know more about how you have used The Club.

Which parts of The Club have you used?

Select all that apply.

The Live Club
The Exercise Club
The Social Club

How often have you used The Live Club?

Daily
2-3 times per week
Once or less per week
Not at all

How often have you used The Exercise Club?

Daily
2-3 times per week
Once or less per week
Not at all

How often have you used The Social Club?

Daily
2-3 times per week
Once or less per week
Not at all

From where do you access The Club?

Select all that apply.

From my own accomodation/home
From a friend’s house/flat
From a family member’s house/flat
From a communal space

Who do you use The Club with?

Select all that apply.

I use The Club on my own
I use The Club with my partner
I use The Club with friends
I use The Club with other family members e.g. son, daughter
I use The Club with a carer

Please tell us 3 things that you liked about The Live Club

If you didn't use The Live Club, write 'n/a.'

Please tell us 3 things that you liked about The Exercise Club

If you didn't use The Exercise Club, write 'n/a.'

Please tell us 3 things that you liked about The Social Club

If you didn't use The Social Club, write 'n/a.'

Confidence and desire to by physically active

We'd really like to know more about how The Club has influenced your confidence and desire to be physically active.

Has your use of The Club increased your confidence to do more household chores?

Select all that apply.

Yes, I can do more heavy household chores e.g. vacuuming
Yes, I can do more moderate household chores e.g. ironing
Yes, I can do more light household chores e.g. dusting
No, there’s been no change

Has your use of The Club increased your confidence to:

Select all that apply.

Go to the shops
Access local facilities e.g. local park
Go up and down stairs – hills/inclines?
Get into and out of motorised transport – e.g. bus or car
Pick up objects from the floor
To join community activities or classes
To meet others in person
To meet others online
Other

If other please specifiy.

Has your use of The Club increased your confidence to do more physical actvites at home?

Yes
No

Has your use of The Club increased your confidence to do more physical activity with friends?

Yes
No

Has your use of The Club increased your confidence to do more physical activity with family?

Yes
No

Has your use of The Club increased your confidence to do more physical activity with a carer?

Yes
No
n/a

How can we improve The Club and the services we offer?

Social engagement

How often do you feel you lack companionship?

Hardly ever
Some of the time
Often

How often do you feel left out?

Hardly ever
Some of the time
Often

How often do you feel isolated from others?

Hardly ever
Some of the time
Often

Security

Follow Up Survey

General

Use of The Club

Confidence and desire to by physically active

Social engagement