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.

What is your gender?

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* 1. What is your gender?

What is your age group?

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* 2. What is your age group?

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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* 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.

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

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

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

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

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

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

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

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

Which of the following symptoms 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)

Please select your interest in the following topics?:

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

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

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

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