Living Well: Workshop Interest Inventory
Chronic Disease Self-Management is an evidence-based, 6 week curriculum designed to teach people how to improve their overall health and well-being while living with a chronic condition. These courses are also open to those caring or living with someone with a chronic condition.

At Homage, we are proud to offer this program in the community. Help us plan for the future by answering the following questions.

Your email address will be entered in a random drawing to receive an Amazon gift card as a thank you for your participation. We will only contact you using this email if your name is drawn.
Email address *
Do you have a chronic condition OR are you caring for someone who has a chronic condition? *
Based on the descriptions of the following curriculum, check the boxes of those you would be interested in attending *
Required
Have you attended any of the Living Well Workshops in the past? *
If yes, do you have any feedback about the workshop you attended?
Your answer
Do you have access to transportation?
How do you enjoy learning? Check all that apply.
What time of day works for you to attend a workshop? Check all that apply.
What is your zip code? *
Your answer
Do you live in a senior apartment community that may be willing to provide meeting space OR do you have access to another type of community space (church, meeting room, etc) that may be willing to host these workshops? If yes, are you willing to provide contact information so we can reach out?
Your answer
Year of birth *
Your answer
What is your gender identity?
Which racial or ethnic groups do you identify with? Check all that apply.
Thank you for taking the time to complete this survey. If you would like us to include you on our mailing list and keep you updated on future Living Well workshops being scheduled, please enter your contact information below before you submit
Email address for upcoming workshop information
Your answer
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