Program Forms

Walk with Ease Paperwork

OsteoArthritis Action Alliance (OAAA) Walk With Ease Data Collection Packet

WWE Participant Information Form  (updated 1/15/2019)

WWE Attendance Log  (updated 11/8/18)

 WWE Participant Post Program Form   (updated 1/15/2019)

Fidelity Evaluation Checklist

 

Updated paperwork for Living Healthy with CDSME workshops

The following forms are required for all CDSME workshops (Program Information Cover Sheet, Attendance Log, and Participant Information Survey):

Program Information Cover Sheet

Attendance Log

Participant Information Survey    (updated 11/8/18)

Tipsheet for Collecting Data

Spanish CDSME Participant Info Survey    (updated 11/29/18)

Spanish Program Info Cover Sheet

Spanish CDSME Attendance Log

Reminder:  If you are in one of the WNC regions (A,B,C,D,E) participating in the Mission Health Partners falls prevention referral pathway, please contact us for the appropriate survey forms.

A Matter of Balance Data Collection Forms

AMOB First Session Survey    (updated 11/13/18) 

AMOB Last Session Survey    (updated 11/13/18)

AMOB Class Info Sheet

AMOB Attendance Sheet

Participant Agreement and Par Q

 

Tai Chi for Arthritis and Falls Prevention Data Collection Forms

Tai Chi First Session Survey   (updated 11/13/18)

Tai Chi Last Session Survey   (updated 11/13/18) 

Tai Chi Class Info Cover Sheet

Tai Chi Attendance Sheet 20 hrs

Participant Agreement and Par Q