WISEWOMAN Participant Screening Form
Wayne County Healthy Communities' WISEWOMAN program is designed to help promote heart health lifestyle changes in women for a healthy long life. The program provides women with health screenings, free health coaching, and healthy incentives that promote healthy behaviors and decrease the risk of heart attack, stroke, and diabetes. To qualify for the program, you must be a woman between the ages 40 and 64. You must also meet the following income guidelines:
1 Person household - $31,225
2 Person household - $42,275
3 Person household - $53,325
4 Person household - $ 64,375
Complete this form to get started today.
Date of Birth
Which health topics/condition is most concerning to you regarding your health?
High Blood Pressure
What are your primary health and fitness goals?
Lower Blood Sugar levels
Lower Cholesterol levels
Lower Blood Pressure
How did you hear about this program?
Hamtramck Health Center
Social Media (e.g Facebook)
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