NACOG Aging Health and Wellness Programs Survey

Health and Wellness Programs Survey

Please complete this survey in order for NACOG Aging to determine what types of classes you are interested in joining. Thank you for your time.
This survey can also be filled out online at:

https://form.jotform.com/232854951692164
1. Date

MonthDayYear
Date
2. Demographics: *Please provide your phone number and/or address if you would like us to contact you regarding future classes in your area!
A Matter of Balance :

An 8 week class that helps older adults reduce their fear of falling by setting goals for increasing activity levels, encouraging small changes to reduce fall risks at home, and ways to exercise to increase strength and balance.
Bingocize:

A 10 week class that combines the fun game of bingo with a health education program that incorporates exercise, nutrition, and falls prevention.
Tai Chi for Balance:

A 16 week class that focuses on improving movement, decreasing falls, and connecting peers. Tai Chi promotes balance, strength, flexibility, immunity, and relaxation.
Stay Active and Independent for Life (SAIL):

A 12 week strength, balance, and fitness program. Classes include building endurance, moving to music, and having the opportunity to incorporate weights as part of fitness training.
Walking, Talking, Coffee Club:

A weekly program that brings older adults together to walk, socialize, and enjoy a cup of coffee or other beverage.
Connections iPad/Chromebook Project:

A 10 week program that provides socially isolated older adults technical assistance on how to use an iPad or Chromebook and increases their social interactions through weekly group activities.
Myself2 people3 people4 or more people
YesNo
Chair YogaHealthy CookingBook ClubOther: __________________________________________________________________________Other: __________________________________________________________________________Other: __________________________________________________________________________
NewspaperSenior/Community CenterLibraryChurchWord of Mouth-friends and familySocial Media (e.g. Internet, Facebook, Instagram)Other: ___________________________
Please answer the following questions if you are interested in the Connections iPad/Chromebook Project:
iPadChromebookEither
Desktop computerLaptop computerSmartphone device (e.g. iPhone, Android phone)Tablet/iPad deviceOther: ________________I do not have any of these devices
YesNoUnsure
11. If yes, which service provider do you have?
Thank you for completing this survey.

Your feedback is highly valued! Please submit this survey online or mail the completed assessment to:

Kristin Moore, NACOG Aging Health and Wellness Specialist

3003 Centerpointe East

Prescott, AZ 86301

928-779-7087

kmoore@nacog.org
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