Wellness Workshop Survey

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I am most interested in my:*
- Structural / Physical Health
- Emotional / Spiritual Health
- Chemical / Nutritional Health
Please select 1
I spend _____ a week taking care of my Structural / Physical Health.*
- 1-3 Hours
- 3-6 Hours
- 6 + Hours
This includes but not limited to cardiovascular exercise (walking/jogging/running), yoga, weight lifting, recreational sports (basketball, soccer) and physical therapy. Please select 1.
I am*
Please select 1
I spend _____ a week taking care of my Emotional / Spiritual Health.*
- 1-3 Hours
- 3-6 Hours
- 6 + Hours
This includes but not limited to worship, meditation, recreational reading, counseling and volunteering. Please select 1
I am*
Please select 1
I spend _____ a week taking care of my Chemical / Nutritional Health.*
- 1-3 Hours
- 3-6 Hours
- 6 + Hours
This includes but not limited to meal planning and prepping (healthy foods of course), nutritional research/counseling and related events. Please select 1.
I am*
Please select 1
I would most likely attend an event on the following topic:*
- Structural / Physical Health
- Emotional / Spiritual Health
- Chemical / Nutritional Health
Please select 1
I am also interested in learning more about Pediatric Sleep Disordered Breathing*
Name
First Last
Email

574-203-5599

TMJ & Sleep Therapy Centre
1245 E. University Drive
Granger, IN 46530

574-203-5599

TMJ & Sleep Therapy Centre
1245 E. University Drive
Granger, IN 46530

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