PDF printable version of Feedback Form (PDF 82 KB)

Choose Health: Be Active aims to help all older Australians:

  • understand the importance of physical activity;
  • become more physically active; and
  • stay active as they get older
Your feedback on this booklet would be very helpful.

Simply answer the questions on the next page by circling your responses and writing any additional comments. Then cut along the dotted line and fold the page so that the address is clearly visible. Seal with tape and, if you can, walk to the nearest post box to post it. No stamp needed.

Your feedback is valuable to us

Feedback form

How useful did you find the information in this booklet?
  • no use at all
  • fairly useful
  • useful
  • very useful
What do you think about the layout of the information?
  • poor
  • fair
  • good
  • excellent
How easy is it to read the text?
  • very difficult
  • difficult
  • fairly easy
  • easy
How easy is it to follow the exercises (drawings)?
  • very difficult
  • difficult
  • fairly easy
  • easy
How useful is the planner the centre of the booklet?
  • in no use at all
  • fairly useful
  • useful
  • very useful
Did you learn anything from reading this booklet?
  • No - nothing at all
  • Only a little
  • Yes - quite a lot
  • Yes - lots
Will you try to increase your level of physical activity or do more exercise after reading this booklet?
  • No – I definitely will not
  • I will think about it
  • I will try
  • Yes – I definitely will
Are you a veteran or war widow?
  • Veteran
  • War widow
  • Neither a veteran nor a war widow
What is your age?
  • Under 60
  • 60-69
  • 70-79
  • 80-89
  • 90 or over