HeySurvey survey

Senior Activity & Well-Being Check-In 🌟

How often do you take part in activities during a typical week?*

Think about hobbies, exercise, social events, classes, or group programs.

Every day
4–6 times a week
2–3 times a week
Once a week
Less than once a week

Which activities do you enjoy most?*

Select all that apply.

Walking or light exercise
Games or puzzles
Arts and crafts
Reading or book clubs
Social gatherings
Music, dancing, or singing
Gardening
Classes or learning activities
Other

How satisfied are you with the activities currently available to you?*

Consider both the variety and how easy they are to join.

1

2

3

4

5

Very dissatisfied to Very satisfied

What makes it easier for you to join an activity?

Share anything that helps you participate more often.

When do you usually prefer to do activities?*

Choose the time that works best for you most days.

Morning
Early afternoon
Late afternoon
Evening
No preference

What challenges make it harder to stay active?

Select all that apply.

Transportation
Health or mobility concerns
Cost
Lack of interest
Not enough time
Activities are too far away
I prefer to stay at home
Need help from a caregiver or family member
Other

How important is social connection when choosing an activity?*

Think about whether being with others affects your interest.

1

2

3

4

5

Not important to Very important

What new activities would you like to try?

You can list one or a few ideas.

Overall, how active do you feel in your daily life?*

Choose the answer that feels most accurate for you.

Very active
Somewhat active
A little active
Not very active
Not active at all

Thank you for taking a part in this survey.

This is a HeySurvey survey template.