One Life Walkers

1. Build Up Black Men - Exercise Your Way to Physical and Mental Health.

Build up Black Men is a FREE community led support group for Black African/Caribbean Men.

We use exercise to help improve the physical and mental well-being of our participants.

This survey will help us to better understand you and your needs and wants, so that we can deliver an effective programme for you.

1. Name *

2. What's your age range? *

3. Are you of Black African/Caribbean heritage?
*

4. Where in Lewisham do you live? *

5. Occupational Status *

6. Do you work or study inside or outside of Lewisham? *

I work inside Lewisham
I work outside Lewisham

I study inside Lewisham
I study outside Lewisham

7. Do you have any children? *

8. Do you currently suffer from any mental illnesses? *

If 'YES', please give details if you feel comfortable.

9. Have you ever suffered from any mental illnesses? *

If 'YES', please give details if you feel comfortable.

10. Are you currently a member of any men’s support groups? *

If 'YES', please give details.

11. Have you ever been a member of any men’s support groups? *

If 'YES', please give details.

12. Do you participate in any sports/physical activities? *

If 'YES', please give details.

13. Do you exercise to help manage your mental health? *

14. Would you attend an exercise group to provide mental and emotional support specifically for black men? *

Yes
No
Maybe

If 'YES' or 'MAYBE', please state what activities you would like to see. E.g. Running club, fitness, football, e.t.c.

15. What is your preferred days/times to attend the group exercise sessions?

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning	Morning Monday	Morning Tuesday	Morning Wednesday	Morning Thursday	Morning Friday	Morning Saturday	Morning Sunday
Afternoon	Afternoon Monday	Afternoon Tuesday	Afternoon Wednesday	Afternoon Thursday	Afternoon Friday	Afternoon Saturday	Afternoon Sunday
Evening	Evening Monday	Evening Tuesday	Evening Wednesday	Evening Thursday	Evening Friday	Evening Saturday	Evening Sunday

Comment:

Use our survey software to make a survey.

One Life Walkers

1. Build Up Black Men - Exercise Your Way to Physical and Mental Health.

1. Name *

2. What's your age range? *

3. Are you of Black African/Caribbean heritage? *

4. Where in Lewisham do you live? *

5. Occupational Status *

6. Do you work or study inside or outside of Lewisham? *

7. Do you have any children? *

8. Do you currently suffer from any mental illnesses? *

9. Have you ever suffered from any mental illnesses? *

10. Are you currently a member of any men’s support groups? *

11. Have you ever been a member of any men’s support groups? *

12. Do you participate in any sports/physical activities? *

13. Do you exercise to help manage your mental health? *

14. Would you attend an exercise group to provide mental and emotional support specifically for black men? *

15. What is your preferred days/times to attend the group exercise sessions?

3. Are you of Black African/Caribbean heritage?
*