Cornerstone Health Survey

To effectively plan for the Wellness Ministry at our church, your input is so very important. Please take a few moments to complete this health survey. All information will be used only for planning health education/programs for Cornerstone. Thank you for you cooperation!

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* 1. Health Information:  Please mark an (X) to indicate the health interest for you and your family (check all that apply)

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* 2. Health Issues: Please mark an (X) to indicate the health interest for you and your family (check all that apply)

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* 3. Specific Illness: Please mark an (X) to indicate the health interest for you and your family (check all that apply)

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* 4. Adult Issues: Please mark an (X) to indicate the health interest for you and your family (check all that apply)

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* 5. Teen and Children's Health: Please mark an (X) to indicate the health interest for you and your family (check all that apply)

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