The object of Fit to a T is to help you assess your risk of osteoporosis, to consider lifestyle changes if you are at risk, and to discuss these risks with your health care professional.  We would like to know how effective this program has been.  Please take a few minutes to complete this evaluation form so that we can continue to improve Fit to a T.  We greatly appreciate your input.

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* 1. Session Host Location

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* 2. Session Date

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As a result of attending this program, which of the following have changed?

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* 3. I have a better understanding of the causes of osteoporosis.

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* 4. I recognize that a broken bone is often due to osteoporosis.

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* 5. I understand that one broken bone increases the risk of more.

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* 6. I am better equipped to discuss osteoporosis with my doctor.

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* 7. I will do better with physical activity, such as walking.

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* 8. I will take better care at reducing my risk of falling.

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* 9. I will be making changes in my diet.

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* 10. I know how to take calcium and vitamin D more effectively.

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* 11. I have a better understanding of drugs to treat osteoporosis.

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* 12. I understand the balance of benefits and risks with treatment.

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* 13. I feel empowered to take better care of my bones.

About you

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* 14. How old are you?

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* 15. Would you describe yourself as:

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* 16. Have you broken a bone since the age of 50?

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* 17. If so, what bone was it?

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* 18. Have you had a bone density test?

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* 19. Have you been told you have osteoporosis?

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* 20. Have you been told you have osteopenia (low bone density)?

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* 21. Do you have one or more risk factors as established by the risk assessment questionnaire?

Comments on the Presentation and Materials

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* 22. Please assess the overall presentation, delivery, content, and time allotted for topic.

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* 23. How complete and effective do you find the handout materials?

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* 24. Additional comments:
(Your comments may be used on our website.)

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* 25. Do you have a question that was not able to be answered during the session?  (If you would like an answer, please be sure to include your contact information.)

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* 26. How can the program be improved?

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* 27. How could the handouts be improved?

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* 28. Name (optional)

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* 29. Email Address

Thank you.  We hope you enjoyed the program.

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