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Community Wellness Survey

  1. Age Range*
  2. How often do you perform physical activity causing your heart rate to rise, breathing rate to increase, and/or cause you to sweat in an average week?*
  3. Please indicate reasons why you’re not more physically active:
  4. What programming would help you achieve a healthier lifestyle?
  5. Leave This Blank:

  6. This field is not part of the form submission.