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Funded by
Living well
Ageing Well
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Participant Details
Name
*
First
Last
Age Group
*
50–59
60–69
70+
Gender
*
Male
Female
Prefer not to say
Ethnicity
*
Language Spoken
*
Phone
*
Email
Health & Support Needs
Any mobility issues?
Yes
No
Any support required?
Which session are you registering for?
Dementia awareness and early help-seeking
Active ageing, mobility, and fall prevention
Culturally appropriate healthy eating and nutrition
Mental wellbeing, loneliness, and emotional resilience
Financial wellbeing and cost-of-living support
Digital inclusion to access NHS services and information
Healthy and active ageing: Decline to contribution
Where did you hear about us?
Friend or family member
Social media
Website
Email
Community group or organisation
Healthcare professional / NHS
Library
Event or community centre
Flyer / Poster
Word of mouth
Other
Consent
I agree to
participate in EMAGE sessions
I agree to
take my photograph
I agree to
anonymised data being used for evaluation
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