In order to help develop the Health Ministry Program at First Presbyterian Church, the Faith Community Nurses would appreciate your thoughts regarding the following questions. All information will be kept confidential.

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* 1. Your age?

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* 2. Please check topics you would like to receive support for and/or learn more about:

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* 3. Other topics:

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* 4. Would you attend a class on any of the above topics?

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* 5. If yes, when would be a good time to attend a class?

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* 6. How would you like to see the faith community nurse/health ministry team used?

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* 7. Additional thoughts and comments:

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* 8. Please leave your name if you would like to speak with a community nurse with any needs or suggestions

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