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.
Do you have a chronic condition OR are you caring for someone who has a chronic condition?
I have a chronic condition
I am caring for someone with a chronic condition
I have a chronic condition AND I am caring for someone with a chronic condition
None of the above
Based on the descriptions of the following curriculum, check the boxes of those you would be interested in attending
Living Well with Chronic Conditions series focuses on problems common to people living with recurring health conditions such as asthma, heart disease, arthritis and hypertension.
Living Well with Diabetes series is designed for people with Type 2, or pre-diabetes, and includes topics like how to manage blood sugar, plan healthy meals and prevent complications.
Living Well with Chronic Pain series addresses medication management, the differences between acute and chronic pain, and exercise plans specifically designed for people with chronic pain.
None of these would interest me
Have you attended any of the Living Well Workshops in the past?
If yes, do you have any feedback about the workshop you attended?
Do you have access to transportation?
Yes, but it's unreliable or limited
Yes, but often I don't feel well enough to leave house
How do you enjoy learning? Check all that apply.
What time of day works for you to attend a workshop? Check all that apply.
I can't commit to a schedule
What is your zip code?
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?
Year of birth
What is your gender identity?
Which racial or ethnic groups do you identify with? Check all that apply.
Asian or Pacific Islander
Black or African American
Native American or Alaskan Native
Hispanic or Latino
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
Send me a copy of my responses.
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