Wellness Program Interest List - Caramel Connections Foundation

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Wellness Program Interest Listccfevents2023-08-27T15:20:17-07:00

Caramel Connections Foundation is excited to introduce our all new program, Whole You Wellness Collective. CCF has partnered with Aligned Community Physicians to offer a FREE wellness program to provide expert guidance and strategies to support your journey towards wellness.

WE ARE CURRENTLY FORMING OUR FALL 2023 INTEREST LIST

REGISTER TODAY!

We are thrilled you are interested in our wellness program! Before you fill out the rest of this form, please read our eligibility requirements to see if you qualify. *

Willing to attend a mandatory orientation on 9/28/2023 from 11:30-1:00 PM
Willing and able to attend a weekly two-hour meeting for the duration of the program, currently set at 12 weeks. Attendance at every meeting is requested.
Willing to have basic medical information (e.g. weight, blood pressure, height, etc.,) for you collected.

Name *

First

Last

Age

City of Residence

Phone Number *

Email *

Do you have diabetes or pre-diabetes? *

Yes
No
Decline

Do you have high cholesterol? *

Yes
No
Decline

Do you have high blood pressure? *

Yes
No
Decline

Do you prefer in-person or virtual? *

In person
Virtual
No preference

Are you pregnant or do you have children? *

Yes
No

If you have children, what are their ages? *

0-5
6-12
13-18
N/A

How did you hear about our program? *

Why do you want to join the program? *

Comment

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