Emmanuel Episcopal Church Health Ministry Questionnaire
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1. Health Ministry Questionnaire

Greetings,

In order to plan for the Parish Nursing Ministry at Emmanuel we need your help. The questionnaire below is designed to determine the needs of our congregation in terms of health concerns and issues.

There is no need to include your name unless you want to.
All information will be confidential and used to plan health programs.

Thank you for your assistance,
Emmanuel Health Ministry

1. What health topics would you like to be informed about:

	Interested	Somewhat Interested	Not Interested
Abuse-Emotional	*What health topics would you like to be informed about: Abuse-Emotional Interested	Abuse-Emotional Somewhat Interested	Abuse-Emotional Not Interested
Abuse-Physical	Abuse-Physical Interested	Abuse-Physical Somewhat Interested	Abuse-Physical Not Interested
Addiction	Addiction Interested	Addiction Somewhat Interested	Addiction Not Interested
Aging	Aging Interested	Aging Somewhat Interested	Aging Not Interested
Arthritis	Arthritis Interested	Arthritis Somewhat Interested	Arthritis Not Interested
Cancer	Cancer Interested	Cancer Somewhat Interested	Cancer Not Interested
Care Giving Ministries	Care Giving Ministries Interested	Care Giving Ministries Somewhat Interested	Care Giving Ministries Not Interested
Children's Health	Children's Health Interested	Children's Health Somewhat Interested	Children's Health Not Interested
Chronic Illness	Chronic Illness Interested	Chronic Illness Somewhat Interested	Chronic Illness Not Interested
Communicable Disease	Communicable Disease Interested	Communicable Disease Somewhat Interested	Communicable Disease Not Interested
CPR	CPR Interested	CPR Somewhat Interested	CPR Not Interested
Diabetes	Diabetes Interested	Diabetes Somewhat Interested	Diabetes Not Interested
Grief & Loss	Grief & Loss Interested	Grief & Loss Somewhat Interested	Grief & Loss Not Interested
Health Care Reform	Health Care Reform Interested	Health Care Reform Somewhat Interested	Health Care Reform Not Interested
Heart Disease	Heart Disease Interested	Heart Disease Somewhat Interested	Heart Disease Not Interested
Immunization	Immunization Interested	Immunization Somewhat Interested	Immunization Not Interested
Joint Replacement	Joint Replacement Interested	Joint Replacement Somewhat Interested	Joint Replacement Not Interested
Medication	Medication Interested	Medication Somewhat Interested	Medication Not Interested
Men's Health	Men's Health Interested	Men's Health Somewhat Interested	Men's Health Not Interested
Mental Health	Mental Health Interested	Mental Health Somewhat Interested	Mental Health Not Interested
Nutrition	Nutrition Interested	Nutrition Somewhat Interested	Nutrition Not Interested
Senior Health	Senior Health Interested	Senior Health Somewhat Interested	Senior Health Not Interested
Sleep Apnea	Sleep Apnea Interested	Sleep Apnea Somewhat Interested	Sleep Apnea Not Interested
Stress	Stress Interested	Stress Somewhat Interested	Stress Not Interested
Stroke	Stroke Interested	Stroke Somewhat Interested	Stroke Not Interested
Surgery	Surgery Interested	Surgery Somewhat Interested	Surgery Not Interested
Teen Issues	Teen Issues Interested	Teen Issues Somewhat Interested	Teen Issues Not Interested
Weight Loss	Weight Loss Interested	Weight Loss Somewhat Interested	Weight Loss Not Interested
Women's Health	Women's Health Interested	Women's Health Somewhat Interested	Women's Health Not Interested

2. Do you have a health care background or interest?

Do you have a health care background or interest?

3. And are you interested in joining the ministry?

And are you interested in joining the ministry? Yes

Maybe

4. If you would like to join our ministry or wish to learn more about how you can assist us, please leave your contact information below.

If you would like to join our ministry or wish to learn more about how you can assist us, please leave your contact information below.

5. Please add additional comments or suggestions:

Please add additional comments or suggestions:

6. Please provide your city of residence so that we might better be able to serve you.

Please provide your city of residence so that we might better be able to serve you. City/Town:
State:
Email Address:

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Emmanuel Episcopal Church Health Ministry QuestionnaireExit this survey