Please help our Health Ministry to better serve you by completing the following survey. This is no need to sign you name. All information will remain confidential and will be used for planning congregation health programs. Thank you for assistance.

Age

Gender

Marital Status

Please indicate if you are interested in learning more about the following topics.

Psychosocial Issues:

Marriage and Family Issues:

Wellness and Prevention:

Practical Life Issues:

Other

What day and time would you be willing to attend a class or group?

Time of Day

Morning Afternoon Evening

Health Ministry Needs Assesment Survey