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Opportunities for Sport or Fitness Participation for Amputees
Demographic Questions
A few questions designed to provide analytical status only for those who respond to this survey. No personal information is asked for.
OK
1.
Please select from the options which would best describe the level of amputation you have?
Hip disarticulation
Knee disarticulation
Trans-femoral
Trans-tibial
Trans-metatarsal
Uni-lateral
Bi-lateral
Other (please specify)
2.
What is your age range?
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older
3.
Please state your gender?
Female
Male
Other
Prefer not to say
4.
What is your location?
Scotland
England & Wales
Northern Ireland
Other
5.
What is your marital status?
Single
Married or domestic partnership
Widowed
Divorced or separated
Prefer not to say
6.
Are you a member of any charity or any other organisation that specialises in providing meets and sporting/leisure activities for amputees?
Yes
No
Current Progress,
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