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  4. Post-Essentrics Class Survey

Post-Essentrics Class Survey

Thank you for agreeing to allow a follow-up survey regarding your experience in this program. Please take a moment to fill out the form below to help ensure that we are providing valuable programs to our community. By completing the survey you help us to continue to offer these programs at no cost to you.

Post-Essentrics Class Survey
(MM/DD/YYYY)
(MM/DD/YYYY)
First
Last
How often do you exercise at home? *
How often are you active? *
How often are you sad or blue? *
How often do you gather with family/friends? *
How often do you fall? *
How many times have you participated in this Essentrics class over the past six-weeks? *
Your level of participation makes a difference in how the program can benefit you personally.
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Mailing Address: 4301 West Markham Street, Little Rock, AR 72205
Phone: (501) 686-7000
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