Arthritis Self-Management Workshop
Registration Form - This is 37 questions and will take approximately 30 minutes.

Disclaimer: If you feel uncomfortable with any questions asked, you DO NOT need to answer them.
This is to help tailor the workshop and its presentations towards the participants' best interest.
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First and last name, preferred pronouns *
Phone Number *
What is your email address? *
Address or PO Box
What kind of arthritis do you have?
How long have you been experiencing symptoms?
Clear selection
What symptoms do you experience? (check all that apply)
Are you currently taking any medications to help manage your condition? If so, which ones?
Do you have any questions about your arthritic condition that you would like answered?
Are you a member of any arthritis support groups? If so, which ones?
Which of the following resources have you found helpful?
Are there any resources you are interested in learning more about?
What do you find most difficult in your daily routine?
Are you aware of any websites and resources to get adaptive equipment?
Clear selection
Do use any adaptive equipment currently?
Clear selection
Has any health professional recommended adaptive equipment?
Clear selection
Do you keep a food journal?
Clear selection
What foods do you find make your symptoms worse?
What foods do you find make your symptoms better?
Do you follow any sort of diet (vegan, keto, gluten-free, etc.)? If yes, what diet? If no, write N/A.
Do you have any food allergies or sensitivities? If yes, to what? If no, write N/A.
How many days a week do you participate in physical activity?
What types of physical activity do you participate in?
Even if you do not currently participate in physical activity, are there any types of activities you would be interested in learning more about?
What factors prevent you from participating in physical activity?
When do you experience the most fatigue during the day?
Clear selection
Does fatigue limit your ability to complete any of the following? (check all that apply)
Do you experience difficulty sleeping through the night?
Clear selection
What techniques do you use to combat fatigue during the day? (check all that apply)
What is your average pain level each day? *
No pain
Severe pain
How would you describe your pain? (check all that apply)
Do you experience morning stiffness?
Clear selection
Does your arthritis impact your ability to do daily tasks?
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Are there certain movements/activities you've started to avoid to prevent pain? If so, what activities? If not, write N/A.
Would you be interested in learning how to cope with anxiety and depression?
Clear selection
Do your currently practice any mental wellness activities?
Clear selection
Are you aware of the signs and symptoms of anxiety and depression?
Clear selection
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