HEALTH & WELLNESS MINISTRY SURVEY Step 1 of 4 25% The Health and Wellness Ministry is working to help people improve the health of body, mind, and spirit. Your input is needed to help focus our efforts on your interests and issues that will best serve the needs of our Sixth Avenue family. Please check all topics that are of specific interest to you. All information is confidential and will only be used for planning purposes. Children's HealthInfant/Child Safety IssuesPoison ControlGrowth & DevelopmentBike/Helmet SafetyFinger PrintingOther:Teen HealthSubstance AbuseAbstinenceEating DisordersObesityExercise & FitnessBullyingOtherAs We AgeMobility/BalanceExerciseSafetyMedicationsEnd-of-LifeDiscussionsAdvanced DirectivesChronic Illness IssuesLong Term Care IssuesAlzheimer’s DiseaseHospiceGrief / Loss IssuesWomen's Health IssuesSubstance AbuseAbstinenceEating DisordersObesityExercise & FitnessBullyingMen's Health IssuesGeneral WellnessHeart DiseaseProstrate CancerHeart DiseaseDiabetesHypertensionSmokingParenting SkillsHealth Promotion / EducationCPR / AEDFirst AidBlood Pressure ChecksSmoking CessationDiabetes ScreeningHealth FairCholesterol ScreeningHome Safety IssuesHIV/AIDS WellnessStress ManagementNutrition EducationWeight ManagementFitnessHeart HealthCancer Prevention / DetectionSupport GroupSupport Group Suggestions: What day of the week and time would you be able to attend a class or group?MondayTuesdayWednesdayThursdayFridaySaturdaySundayTime preference?Time Preference?I Can VolunteerHealth MinistryChurch Nurse ProgramHealth Expertise (if applicable):List Health Expertise & Areas of Interest Age18-2930-3940-4950-5960-6970-7980 +GenderMaleFemaleMarital StatusSingleMarriedDivorcedWidowedLive AloneChildren in Household?YesNoIf Yes, How many?List ages (separated by commas) Exercise per week1-2 x week3-4 x week5-7 x weekRate your healthExcellentGoodFairPoor THANK YOU FOR YOUR PARTICIPATION!!