Health behaviour and illness perception in cardiac

You are:

Female

Male

Please state your age:

What is the highest level of education you have completed?

Primary school or no education

Secondary school

Sixth form / college

University level education

Masters / PhD

Please state your marital status:

Single/never been married

Married

Divorced

Widowed

Please state how long approximately you are attending cardiac rehabilitation classes?

Leave this blank if you are not a member of cardiac rehabilitation classes.

During all this time, how many of the classes have you approximately missed?

none

1-2

3-5

5 and more

On average, how many units of alcohol do you drink per week?

One unit = 1/2 pint of beer or 1 glass of wine or 1 pub measure of spirit

Do you smoke cigarettes?

Yes

No

If your answer is yes: For how many years have you smoked?

Do you exercise?

Yes

No