For Providers Add FAQ and Instructions For Community Members Add FAQs and Instructions Contact Information First Name: Last Name: Personal (Patient) Email: Provider Email (Optional): Address: County: Optional Section Are you a health provider? Yes No Title: Name: How Ready Do You Feel? How ready are you to make life changes for your health? 1 2 3 4 5 6 7 8 9 10 What can you do today that is good for your health? Date/Time Date/Time: Date Date/Time: Time Select Food Examples: try new recipe, drink more water, eat less sugar Movement Examples: walk, exercise, stretch Nature Examples: Meet with friends at the park, bird watch, mediate outside I will … I will … I will … Resources: Resources Food Movement Nature Submit
