Pre-Yoga Class Survey What is today’s date? * (MM/DD/YYYY) Enter your birthday * (MM/DD/YYYY) First First Last Last Phone Email Where is this class located? * in-person at the Schmieding Center (Springdale) via Zoom How often do you exercise at home? * All the time Often Sometimes Never How often are you active? * All the time Often Sometimes Never How often are you sad or blue? * All the time Often Sometimes Never How often do you gather with family/friends? * All the time Often Sometimes Never How often do you fall? * All the time Often Sometimes Never Radio Field * Yes, you may follow up No, do not follow up We would like to follow up with you in six-weeks to evaluate your progress. Please select your preference below. If you are human, leave this field blank. Submit
