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PraXis Get to Know You
All information will be kept strictly confidential. Answers do not disqualify someone from the program. The PraXis program is a survey of the efficacy of wellness practices in a Christian context. The program is not a church, nor is it medically diagnostic or therapeutic in nature.  More info on the program www.PraXisWellness.Center

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Welcome to the PraXis Wellness Change. Sept 21 to Nov 11. Tell us a little about yourself.
Name *
Age *
How did you hear about this program? *
Time Zone *
Spiritual Affiliation
If affiliated, how averse or engaged are you with the institution of your religious affiliation
Clear selection
Are you engaged in a spiritual community outside of an institutional church
Clear selection
If you currently exercise, how often do you exercise
Clear selection
If you exercise, what form do you engage in
Clear selection
How averse or interested are you with fitness practices
Clear selection
Do you have experience with following dietary disciplines
Clear selection
How averse or interested are you with the idea of dietary disciplines
Clear selection
Do you have experience with any of the following silent practices
Clear selection
How averse or interested are you in silent practices
Clear selection
How would you rate the feeling of your overall physical health. (One is the healthiest you have ever felt with five being currently feeling unhealthy).
Clear selection
Please check any of the follow injuries or conditions. Check all that apply.
Do you have trauma history that might factor into your participation in the PraXis program? (we are not asking for specifics)
Clear selection
In future surveys, would you be willing to disclose emotional and mental health challenges?
Clear selection
Are there any other specific physical, or mental health challenges you think we should be aware of at this time?
Clear form
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