Yellowhawk Client Activities Outreach Question Title * 1. Do you currently receive services from Yellowhawk Health Center? Yes No Question Title * 2. Have you been diagnosed with diabetes? Yes No Question Title * 3. Have you been informed by a medical professional that you are pre-diabetic? Yes No Question Title * 4. What prevents you from attending health improvement activities or events? Transportation I can’t attend 7:30am – 5pm I can’t attend during week-days I am not interested in group activities Other Question Title * 5. I am able to attend activiities on the following days and times Monday - 7:30 am – Noon Monday - Noon – 4:00 pm Monday - 5:00 pm – 8:00 pm Tuesday - 7:30 am – Noon Tuesday - Noon – 4:00 pm Tuesday - 5:00 pm – 8:00 pm Wednesday - 7:30 am – Noon Wednesday - Noon – 4:00 pm Wednesday - 5:00 pm – 8:00 pm Thursday - 7:30 am – Noon Thursday - Noon – 4:00 pm Thursday - 5:00 pm – 8:00 pm Friday - 7:30 am – Noon Friday - Noon – 4:00 pm Friday - 5:00 pm – 8:00 pm Saturday - 7:30 am – Noon Saturday - Noon – 4:00 pm Saturday - 5:00 pm – 8:00 pm Other (please specify) Question Title * 6. What style of activities or events most interest you? Group sit & listen style Individual sit & listen Group active, doing things Individual active, doing things In home video’s or via internet At Yellowhawk videos or via internet All of the above Other Question Title * 7. Thinking of your health, what kind of information would be beneficial to you and how would you like it presented? Group cooking classes Individual cooking classes Group swim classes Individual swim classes Group cycling Individual cycling Group walking Individual walking In home video’s or via internet At Yellowhawk using videos with a trainer Other (please specify) Question Title * 8. Would you be interested in attending a regularly scheduled cooking class? Yes No Question Title * 9. What style of cooking classes would you be interested in attending? Family classes in your home Family classes at Yellowhawk Individual classes in your home Individual classes at Yellowhawk Preparing the college student for cooking away from home All of the above Other (please specify) Question Title * 10. Other than cooking classes what other nutritional subjects would you like to learn about? Healthy & cost effective shopping skills Creating healthy meals with commodities Recipe sharing center - electronic and mailings Meal Planning Seasonal food preparation/storage Gardening at home Other (please specify) Question Title * 11. What should we include in a cooking class that would make it more interesting to you? New recipes for deer and elk Meal planning with commodity foods Other (please specify) Question Title * 12. What are the days and times that are open for you to attend events? Weekdays / 7:30 – 4:00pm Weekdays / 5:00pm – 8:00pm Saturday mornings Saturday evenings Sunday mornings Sunday evenings Prefer to have a class tailored for me in my home All of the above Other (please specify) Question Title * 13. What are the locations that you would most likely attend activities? In Mission In Pendleton Round-Up Athletic Club Wildhorse Resort Golf Course Group walks at Tamastslikt Group walks in Mission Group walks on the Tamastslikt trail All of the above Other (please specify) Question Title * 14. We have a high number of ‘no shows’ for diabetes follow-up education sessions, these are the appointments that occur after goal-setting. What makes you want to return? Question Title * 15. We have a high number of ‘no shows’ for diabetes follow-up education sessions, these are the appointments that occur after goal-setting. What makes you not want to return? Question Title * 16. What would increase your interest in attending our monthly Diabetes Self-Management Education classes, currently the class is one full day? Shorter classes offered over several days Shorter classes offered once per week An evening series Question Title * 17. What would increase your interest in attending our monthly Diabetes Support Groups? Question Title * 18. Would you be interested in helping out with our Community Garden to increase fresh produce availability? Yes No Question Title * 19. Do you have access to the internet? Yes No Question Title * 20. Do you have an email address that you check regularly? Yes No Please insert your email address here if you would like to receive health updates? (your email will not be shared) Question Title * 21. What is your age? Under 18 19 – 25 26 - 35 36 – 45 46 – 55 56 – 65 66 – 75 76 – older Question Title * 22. What is your gender? Male Female Done