Suitability Questionnaire

Your name*

Have you made any changes to your health or lifestyle since your diagnosis?*

Yes - definitely

No - not at all

Yes - a little bit

What supports do you have?*

I live with someone who would support me on this progam

I have family or friends who I don't live with who would support me on this program

How flexible are you with food?

Not at all - I wouldn't change anything even if there was good scientific evidence that I should.

I would reluctantly change the food I eat only if there was good scientific evidence.

I am reasonably flexible with food that I eat, especially if there is a good scientific reason.

No problem - tell me what to eat (and why!) and I'll give it a go.

How active are you?*

I engage in physical activity less than once a week

I engage in physical activity at least once a week

I am active every day

Would you make an effort to add some personalised exercises to your lifestyle?*

Yes

No

Do you see any doctors in Australia?*

I have a regular GP

I have a geriatrician

I see another specialist/other specialists

None regularly

Do you think that the ReCODE program would be quick and easy?*

Yes

No

Please give me any more information on the above you would like to share.