HWF Research Project: Final Survey

Final Survey

Dear Research Participant,
We are delighted you have participated in this important Healer Within Foundation research project. Please complete this FINAL questionnaire.

Your responses will remain anonymous. We thank you sincerely for your time and feedback!

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* 1. Your Information:

Practice Leader Name (Your Teacher or Group Leader)

State (If virtual, the state your Practice Leader is in)

Your Email Address (this is your unique ID for research purposes only)

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* 2. Sex

Male

Female

Rather Not Say

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* 3. Your Age (in years):

Rate the following questions on a 1 to 5 scale, 1 = strongly disagree and 5 = strongly agree:

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* 4. What are the improvements you experienced in practice of Qi Gong/Tai Chi? (Please check all that apply)

Decreased stress, anxiety and depression

Improved mood

Improved heart/lung strengthening

Increased energy and stamina

Improved flexibility, balance and agility

Reduced pain

Improved muscle strength and definition

Other improvements

No improvements noted

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* 5. Is there any change with your prescription drug use? (Please select one)

Reduced the numbers of kinds of medications

Reduced number of pills

Reduced dosage amount

No change

N/A: I do not use any prescription drugs

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* 6. My goals were met. (Please select one)

Yes

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* 7. I will continue to practice Qi Gong/Tai Chi? (Please select one)

Yes

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* 8. Qi Gong/Tai Chi is helpful to me. (Please select one)

Yes

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* 9. I will recommend Qi Gong/Tai Chi to my family and friends? (Please select one)

Yes

HWF Research Project: Final Survey

Final Survey

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* 1. Your Information:

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* 2. Sex

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* 3. Your Age (in years):

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* 4. What are the improvements you experienced in practice of Qi Gong/Tai Chi? (Please check all that apply)

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* 5. Is there any change with your prescription drug use? (Please select one)

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* 6. My goals were met. (Please select one)

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* 7. I will continue to practice Qi Gong/Tai Chi? (Please select one)

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* 8. Qi Gong/Tai Chi is helpful to me. (Please select one)

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* 9. I will recommend Qi Gong/Tai Chi to my family and friends? (Please select one)

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* 10. What suggestions do you have for us to improve the class and this survey?