Health Monitoring

Questions marked with an * are required

I feel healthier and stronger during daily activities?

Yes

No

Sometimes

I can participate in my favorite activities

Yes

No

Sometimes

* I talk with my caregivers, physicians and family about my dietary needs

Yes

No

Sometimes

My physician reports that my health is improving through check-ups, blood work and health outcomes.

Yes

No

* I feel like I need additional education about dietary changes for my caregivers and family

Yes

No

I talk to my friends about making lifestyle changes to improve their health too.

Yes

NO

Sometimes

* Eating at the Senior Center each week improves my mood, and I get to eat with my peers/friends

Yes

No

Sometimes

* The barriers to a healthy diet have not kept me from changing my diet and my health.

Yes

No

* I would like the Health Educator to come make a presentation at my local organization meeting or Church meeting.

Yes

No

I need additional information

* I would recommend this nutritional education to all ages, races, and nationalities for improved health of the nation.

Yes

No

Maybe