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Wellness Activities Survey
Hendricks community Hospital Association is interested in the health and wellbeing of our community. Last year we conducted a Community Health Needs Assessment (CHNA) and the CHNA identified a need for more health and wellness activities in our community. The following survey is intended to gather additional information that will be used to help establish priorities for our organization to continue to improve the health and wellness for our community. Thank you in advance for taking the time to provide us your input!
Do you currently participate in any of the following activities?
Yes, in Hendricks or at my home
Yes, out of town
No
Yoga class
Senior fitness class
Aerobics class
Walking track
Weight lifting
Use fitness machines
Basketball
Pickleball
Racquetball
Batting cage
Swimming
Dance class
Shooting range
Golf simulator
Youth fitness classes
Other
If Other, please specify
If the following activities had increased opportunities in Hendricks how often would you or a member of your family participate?
More than 1 time per month
A few times per year
Not of interest
Yoga class
Senior fitness class
Aerobics class
Walking track
Weight lifting
Use fitness machines
Basketball
Pickleball
Racquetball
Batting cage
Swimming
Dance class
Shooting range
Golf simulator
Youth fitness classes
Other
If Other, please specify
Do you feel there is a current need for a community center in Hendricks? If yes, what do you feel is the greatest need for having one?
Could we contact you to assist us in developing an activity that you have expressed interest in?
Please select
Yes
No
Do you or a member of your family work at a business/organization in Hendricks?
Please select
No
HCHA
Hendricks school
Lincoln county
Other
If Other, please specify
Tell us about your household. How many people in each age range are there?
Children (0-18)
Adults (19-50)
Adults (50+)
Name
*
First
Last
Phone
###
-
###
-
####
Email address
Enter your zip code
*
