Congregational Health Ministry Survey

To help plan for health ministry in our faith community, your    assistance in answering the following questions is important. There is no need to sign your name unless you would like to be         contacted. All information is confidential and will be used for planning programs in our congregation.

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* 1. Please Indicate your age

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* 2. Please indicate your gender:

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* 3. Please indicate your marital status:

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* 4. Health status: Please mark all that apply

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* 5. Support Groups can be developed to meet the needs and    interests of the greatest number of people. Please mark which groups you'd be interested in participating in on a regular basis. If you are currently participating in a group of this sort, please indicate that in the "other" section.

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* 6. Classes: The following are health promotion/education classes that may enhance your emotional, physical and spiritual health. Classes will be developed to meet the interests of the greatest number of people. Please indicate if you would participate in any of the following.  Mark as many as you have interest.

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* 7. What is/are your or your family’s major health concern(s)—physical, emotional and/or spiritual?

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* 8. What area of need in our congregation with which you would like to see a health ministry?

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* 9. Do you have experience in any health topic in which you would be willing to teach or share your experience? If so, please share how you'd like us to contact you. 

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* 10. Would you be interested in sharing some of your time as a volunteer? If so, please indicate your area of interest and share your name and contact information below. Training will be provided.

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