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Sign up for Chronic Disease, Chronic Pain, and/or Diabetes Self-Management workshops or Fit and Strong or Health Coaches for Hypertension Control Workshops
1.
Name:
2.
Phone number:
3.
Email Address:
4.
What city or town do you live in?
5.
Sign up for a Self-Management workshop (all workshops are 6 weeks, with one session per week): Chronic Disease (for people with chronic disease or a caregiver), Chronic Pain (for people with chronic pain or a caregiver), and/or Diabetes Self-Management (diabetics, pre-diabetes and caregivers,).
Yes
No
Would like more information
Chronic Disease Self-Management Workshop
Yes
No
Would like more information
Chronic Pain Self-Management Workshop
Yes
No
Would like more information
Diabetes Self-Management Workshop
Yes
No
Would like more information
6.
For Chronic Disease, Chronic Pain. and Diabetes Self Management classes have two ways we can teach the class. One-hour class is a shorter, more condensed version of the 2.5 hour class. Both versions of the class are for 6 sessions for 6 weeks. Would you like to attend:
One-Hour class
2.5 hour Class
Either class
7.
What time(s) works best for Chronic Disease, Chronic Pain. and Diabetes Self-Management Workshop.
Morning (between 9 am and Noon)
Afternoon (Between 1:30 pm and 5 pm)
Evening (starting at or after 5 pm
Other (please specify)
8.
Fit & Strong! (24 sessions each 90 minutes over 8 or 12 weeks). What workshop would you like to sign up for:
Over 8 weeks, on Monday, Wednesday, and Fridays for 90 minutes each session
Over 12 weeks, on Monday and Wednesday for 90 minutes each session
Over 12 weeks, on Tuesday and Thursday for 90 minutes each session
9.
Health Coaches for Hypertension Control (help people with high blood pressure better manage their condition) for 1.5 hours weekly for 8 weeks.
Morning (between 9 am and Noon)
Afternoon (Between 1:30 pm and 5 pm)
Evening (starting at or after 5 pm
Other (please specify)
Current Progress,
0 of 9 answered