Living Healthy At Home - Interest Form

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Due to COVID-19, we cannot currently offer the Living Healthy with Chronic Conditions workshop in person.

However, we are pleased to announce that we are offering a no-cost toolkit and phone-based version of the program called Living Healthy At Home. You will only need access to a telephone for this program.

If you are interested in learning more, please fill out the form below and we will be in touch within 5 business days. Your information will be kept confidential. For questions, contact MaryLou White at agewell@ptrc.org or 336-497-5610.

What is your first and last name? *

What is the best phone number to reach you? *

If you have one, what is your email address?

What is your mailing address? (if you decide to participate in the program we will be mailing a toolkit to your house). *

Have you ever taken a Living Healthy workshop before? *

Yes

Unsure

Classes are offered once a week for 6 weeks. Each class is one hour. We will attempt to match you with a class that best fits your schedule. Would you be available to participate? *

Yes

What is your time preference for this phone-based class? (please select all that apply) *

Morning (i.e. 9 - 10)

Lunch time (i.e. 11 - 12, 12 - 1)

Afternoon (i.e. 2 - 3, 3 - 4)

Required

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