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November 2020 Community Wellness Survey
1.
How would you rate your overall health?
Excellent
Good
Fair
Poor
Very Poor
2.
I have stopped doing certain activities because I am afraid of falling.
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
3.
I am under a doctor's care for chronic health conditions (arthritis, diabetes, depression, etc.)
Yes
No
Prefer not to answer
4.
I am taking steps to improve my overall wellness.
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
5.
I feel good about my emotional health.
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
6.
On a scale from 0-5, how interested are you in participating in any health and wellness programming? (0 being not at all, 5 being very much interested)
0
5
Clear
7.
Are you interested in participating or learning more about any of the following (please mark all that applies).
Nutrition education
Exercise class
Fall Prevention class
Parkinson's Disease class
Bingo
Monthly health challenges
Stress relief/management
Financial education
Caregiver support group
Caregiver programs
Nicotine cessation class
Diabetes education class
Medication compliance class
Arts and crafts
Other (please specify)
8.
Are you comfortable with using technology to participate in health and wellness programs?
Yes
No
9.
How can Thrive Alliance help you improve your overall health and wellness?
10.
What county do you reside in?
Bartholomew
Brown
Decatur
Jackson
Jennings
Other (please specify)
11.
How old you are today?
12.
If you would like to be contacted in regards to health and wellness programming that Thrive Alliance offers, please leave your name and contact information.
13.
Any additional comments.
Current Progress,
0 of 13 answered
