Phase II Physical Activity Site Visit/Consultation

Thank you for participating in Phase II of the Body&Soul+ Program.

Please complete and submit this report within 60 days after your consultations (including the site visit) have been completed. We understand that you may need to discuss results of the visit(s) and your potential plan with your health/wellness team or organizational leadership before submitting your final plan. You may want to write your answers down on another sheet of paper, and then enter all the answers when you have them.

As always, thank you for your time and feedback.

* 1. What is your name?

* 2. What is the name of your house of worship?

* 3. What were the dates of your in-person site visit?

* 4. Were there any other members from your house of worship who participated in the site visit, or development of your Physical Activity Plan?