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.

* 1. What is your gender?

* 2. What is your age group?

* 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.

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

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

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

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

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

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

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

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