Participant Pulse

Please fill out the following questions regarding participant's health and wellness. The Arc is in the process of developing a wellness program for the people we serve. Your answers will help us in defining current needs and leveraging important funding to run the program. Thank you for your time.

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* 1. What is your gender?

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* 2. What is your age group?

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* 3. On average, how many total minutes a day are you doing moderate aerobic exercise? Count only the times you are active for 10 minutes or more.

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* 4. Which of the following physical fitness activities do you participate in? (check all that apply)

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* 5. On average, how many serving of fruits and vegetables do you eat per day?

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* 6. How much do you agree with the following statements? (check all that apply)

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* 7. Which of the following medical issues do you currently experience? (check all that apply)

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* 8. Which of the following symptoms do you currently experience? (check all that apply)

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* 9. Please select your interest in the following topics?:

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* 10. Please let us know of any specific needs your family needs around health and wellness.

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