Holy Cross Catholic Church

Your Age

Under 20

20-29

30-39

40-49

50-59

60-69

Over 70

In what ways would you like to see parish nurses and Health Ministry active in our community?

Health education

Personal health counseling

Health referrals

Visitation of hospitalized / homebound

Screening programs

Advocacy

Which health topics impact you, or you'd like to learn more about?

Blood pressure

Cancer

Arthritis

Lung / respiratory disease

Diabetes

Mental illness

Depression / Anxiety

Stroke

Heart disease

Cholesterol

Alzheimer's disease / dementia

Which other topics interest you?

Know your medications

First Aid / Safety

CPR Instruction

Exercise

Parenting

Strategic Grandparenting

Advance Directives

Freedom from smoking

Self-esteem

Babysitting tips

Stress and coping

Healthy eating / nutrition

Weight management

Medicare / navigating insurance

Caring for aging relatives

Hospice care

Spiritual growth / prayer

Bereavement

Caregiver stress / respite care

Would you attend a session on any of the topics marked above?

Yes

No

If yes, when would be the best time?

Weekdays, daytime

Weekdays, evenings

Saturday morning

Please contact me with more information about:

Volunteer (as a Registered Nurse)

Volunteer (any other background)

Add me to a participant email list

None of the above

Name

First Name

Last Name

Phone

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