Wayne SDA Church - Anonymous Health Questionnaire
Anonymous form to self-assess the collective health needs of the church family. This information will be used to tailor health programs and activities by the Health and Temperance Department in 2018 - 2019.
I am *
My age group is... *
My weight is... *
Your answer
My height is... *
Your answer
My diet is... *
I believe there is a link between my physical health and my spiritual health *
I want to be healthier *
I would like to learn more about... *
Required
I currently take [enter number of] daily prescription medications *
Your answer
I have diabetes or pre-diabetes *
Would you be interested in participating in an eight-week workshop proven to reverse diabetes? *
I have heart disease *
I have arthritis *
I have high blood pressure *
I have or have had cancer *
I think our church should emphasize health more/less *
Would you be willing to participate in a church-wide health improvement plan? *
Have you participated in the Let's Move Day 5K in the past? *
Would you like to volunteer to help during the Let's Move Day 5K event? *
Would you like to join the Health & Temperance team?
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