Registration2

Basic Training for Optimal Health

Pre-requisite:

Achieving Optimal Health Workshop

Registration:

* Indicates required field

Name: *

First

Last

Church Status: *

Member Guest

If "Guest," name of Sponsor: *

First

Last

The Name of the person that invited the Guest.

Phone #: *

For text messages only.

Email: *

Age: *

Gender: *

Male Female

Refer to your Worksheets from the Achieving Optimal Health Workshop for your responses to the items below.

Health Risk Level: *

0-2 = Low Health Risk 3-5 = Moderate Health Risk 6-12 = High Health Risk

Refer to your "Exercise D" Worksheet.

Averaged Health Belief Level: *

Refer to your "Exercise B" Worksheet.

Target Un-Healthy Behavior: *

Specify the unhealthy behavior that you intend to change.

Stage of Change: *

Pre-Contemplative Contemplative Preparation Action Maintenance Termination

Refer to your "Exercise C" Worksheet.

Question or Comment (optional): *

Submit

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Creating a Culture of Optimal Health

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