MMM…Monthly Monday Meditation "*" indicates required fields Step 1 of 2 50% Date MM slash DD slash YYYY Birthday * Required MM slash DD slash YYYY Enter required information below. * Required First Last Email * Required Phone * RequiredResidence County * RequiredBentonWashingtonMadisonBaxterBooneCarrollIzardMarionNewtonSearcyStoneotherGender * RequiredMaleFemaleOtherRace * RequiredAfrican-AmericanAmerican IndianAsian/Pacific IslanderCaucasianHispanicMiddle EasternOtherProfession * RequiredPublic/CommunityDieticianMedical StudentNursingNursing Home AdministrationParaprofessionalPatientPhysical TherapyPhysicianResidentSocial WorkStudentHow did you learn about this program?(check all that apply) Facebook Website Word of Mouth My Center on Aging (the Schmieding Center) My Healthcare Provider (e.g., doctor, nurse, etc.) Other Will you participate via Zoom or In-Person? * RequiredZoomIn-Person Survey data is required by our funder to offer this program at no cost to participants. Only aggregate (group) data from this survey is reported.How would you describe your overall health? * Required Excellent Good Fair Poor SCSHE How would you describe your knowledge of how stress or tension impacts your health? * Required Excellent Good Fair Poor SCSHE How would you rate your understanding of how relaxation can help with tension or stress? * Required Excellent Good Fair Poor SCSHE How would you rate your confidence in managing your tension or stress? * Required Excellent Good Fair Poor SCSHE How would you rate your confidence taking charge of your health? * Required Excellent Good Fair Poor SCSHE How would you rate your confidence making a plan for good health? * Required Excellent Good Fair Poor SCSHE
