Church of the Red Rocks 2011 Health Survey

• Which of the following health promotion classes would you participate in if they were offered at the Church?  (note:  there may be a fee involved)

  CPR Healthy Eating Blood Sugar Testing Weight Management Flu Shots Funeral Planning Organ Donation

  Hospice Exercise Class First Aid Blood Pressure Screening Diabetes Info/Counseling Advanced Directives

  
  
• Did any of the following keep you from obtaining adequate medical care in the last year?
  
  • Lack of Transportation:   Yes   No  
  • Do not have Family Doctor:   Yes   No  
  • No Insurance:   Yes   No  
  • Unsure where to go:   Yes   No  
  
  
• Would you be willing to volunteer for the church's Health Ministry in any capacity? Yes   No   Maybe at a later date  
  If yes or maybe, please type in your name, contact information and specify your area(s) of interest:
  
  
  
• If you have professional health experience/expertise, would you be willing to teach or share it?
  Yes   No   Maybe at a later date  
  
If your answer is yes or maybe, please type in your name, contact information and specify your area of experience or expertise:

Check your answers. If you want to re-do and re-type your answers, click the "CLEAR FORM" button below to clear the form of your responses.

When satisfied with your survey responses, please send by entering 5 letters or numbers in the box below then clicking on the "Send To Church Office" button below.

Thank you for helping us make your Health Ministry
more relevant and helpful for you!
Betty Morgan, RN, FCN
Parish Nurse