JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Survivorship and Health & Wellness Community Survey
In an effort to inform survivorship and health and wellness programming opportunities, The Hormel Institute is seeking community input on services and activities you would like to see provided within Mower County.
We value your feedback. Thank you!
Sign in to Google
to save your progress.
Learn more
Which of these
Free
Rural Health
services would you be interested in? (check all that apply)
Preventative Screenings - For example - Blood pressure screenings, Blood sugar/A1c checks, Cholesterol checks
Health/Wellness Education - For example - How to lower blood pressure, How to lower A1c
Mental Health Screenings
Hearing/Vision Screenings
Lead Screenings
HIV/STI Testing
BLS (Basic Life Support) Training
Emergency Medical Services (EMS) Training
None of the above
Other:
Which of these
health/wellness
opportunities would you be interested in? (check all that apply)
Health/wellness seminars- including research findings
Hands on classes - For example: Healthy Cooking Classes, Meditation class, Yoga Class
Food & Nutrition Education seminar
Chronic Disease Prevention and Management seminar
Stress Management/Mindfulness resources
Substance use prevention seminar
None of the above
Other:
Which
Cancer Survivorship/Caregiver
opportunities would you be interested in?
Cancer Survivorship Definition - The health and well being of a person with cancer from the time of diagnosis to the end of life. This includes the physical, mental, emotional, social and financial effects of cancer.
Workshop session with speakers and discussion
Informational Seminar of cancer related research findings
Support Group for Cancer Survivors
Support Group for Caregivers
None of the above
Other:
Considering the options you selected above, which program format would you prefer?
In-Person
Hybrid (option to attend in-person or online)
Online
Other:
If you were to attend in-person, where would you prefer to attend? (Please check all that apply)
The Hormel Institute, Austin
Community Spaces, Austin
Community Spaces, Greater Mower County
Other:
How often would you be interested in participating in the events/activities indicated above?
Monthly (12 times a year)
Quarterly (4 times a year)
Annually (Once a year)
Other:
Clear selection
How long would you prefer each event/activity to be?
1 Hour or Less
1-2 Hours
Half Day
Full Day
Other:
Clear selection
What is the best way for you to be informed about upcoming events? (check all that apply)
Newspaper
Flyers around town
Email
Facebook
Other Social Media
Community/Church Newsletters
Other:
What health, wellness or cancer survivorship resources do you wish were available in our area?
Your answer
Please include any other additional comments or ideas in the space below. (optional)
Your answer
If you would like to be contacted about future events at The Hormel Institute, please provide your email address below.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Minnesota Twin Cities.
Report Abuse
Forms
