Reports generated from data collection are valuable for everyone — participants, community sites, funders and policymakers.
These reports are helping the evidence-based movement not only locally in your own communities, but nationally.
The forms below can be completed as a fillable PDF or they can be printed out to serve either virtual or in-person workshops.
Please contact healthyagingncinfo@gmail.com if you have any questions about the forms.
Leaders and Coaches: Please print out the Program Forms Guidance Flowchart before beginning a workshop to assist you with data collection.
Download and share the one-pager: Using Fillable Portable Document Files for Survey Data Collection
Health Coaching
Once assigned to a health coach, all forms will be administered through the Healthie Platform.
A Matter of Balance
Participant Agreement Par-Q Fillable
AMOB Program Info Cover Sheet Fillable (7/29/21)
AMOB Attendance with TUG Fillable (7/29/21)
AMOB Participant Info Form / First Session Survey Fillable (7/29/21)
AMOB Post Session Survey Fillable (7/29/21)
AMOB Fidelity Checklist
Tai Chi for Arthritis and Fall Prevention
TCA/FP Registration Form Fillable
Participant Agreement Par-Q Fillable
TCA/FP Program Info Cover Sheet Fillable (7/29/21)
New 16 Session TCAFP Attendance for Virtual Fillable with Totals (Sept. 2023)
TCAFP Attendance for Virtual Fillable with Totals (7/29/21)
TCAFP Participant Info Form / First Session Survey Fillable (7/29/21)
TCAFP Post Session Survey Fillable (7/29/21)
TCAFP Fidelity Checklist
Walk With Ease
Please use workshop forms in Mon Ami system. If you are unable or having difficulty using Mon Ami for workshop management, please contact Nadia Mazza, Senior Project Manager – CDC Arthritis. The links below are for reference only (not for data collection).
WWE Participant Information Form Fillable
WWE Attendance Log Fillable
WWE Post Program Form Fillable
WWE Fidelity Evaluation Checklist Form Fillable
Chronic Disease Self-Management Education (CDSME) Programs
Attention All Chronic Disease Program Providers:
NEW 2023 fillable CDSME program forms are HERE! See links below. AND the new CDSME forms have been uploaded to the Mon Ami database for partners to complete their workshop data entry process. All previous versions of CDSME forms are no longer valid as of August 31, 2023.
CDSME Cover Sheet with Fillable Fields (top line/blank for program name) (7/6/23)
CDSME Attendance Log with Fillable Fields (top line/blank for program name) (7/6/23)
CDSME Participant Pre and Post Survey Set with Fillable Fields (7/6/23)
Tipsheet for Collecting Data
CDSME Fidelity Checklist