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Interest Checklist

1 Name: .. Hosp No: .. Date Of Birth :.. Interest Checklist Category Activity Degree Of Interest Do You Currently participate? (yes/no) Strong Interest Some Interest No Interest1 Health & Fitness Complimentary Therapies/Healthy living Cycling Exercise/Aerobics/Gym Swimming

Singing . Making music . Writing – letters/poems/stories . Fashion – incl. Clothes/Hair Care/Cosmetics . Photography . Painting/Drawing (Art) Model building

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