Data Collection Sheet: Pharmacy Change4Life Like A Jedi’ Campaign: August 2018 ’Train Pharmacy name: Address: Please record the basic information for individual receiving intervention / advice during the each campaign: Age Type of intervention No. Gender 1- 18 1 None 2 19-29 – (M / F) – 2 Info advice / Guidance / Leaflets – 3 30-39 – 3 Referral to GP or local physical activity / lifestyle service if – 4 40-49 – concerned about lack of activity / weight or other lifestyle factors 5 50-59 – 6 over 60 –
Data Collection Sheet: Pharmacy Change4Life ’Train Like A Jedi’ Campaign: August 2018 Pharmacy name: Address: Please record the basic information for each individual receiving intervention / advice during the campaign: No. Gender (M / F) Age 1- 18 2 – 19-29 3 – 30-39 4 – 40-49 5 – 50-59 6 – over 60 Type of intervention 1 – None 2 – Info advice / Guidance / Leaflets 3 – Referral to GP or local physical activity / lifestyle service if concerned about lack of activity / weight or other lifestyle factors
Data-collection-sheet-Jedi.docx