An initiative of The N.C. Center for Health & Wellness at UNC Asheville | Statement of Compassion & Inclusion

TCA/FP First Session Survey

TCA/FP First Session Survey OMB Control No. 0985-0039 Exp. date 03/31/2021

By filling out this form, I agree that the information collected on program forms may be studied and shared, with no way to link it back to me.

  • MM slash DD slash YYYY
  • (first two letters of your first name, first two letters of your last name, last two numbers of your birth year)
  • The next few questions ask about falls. By a fall, we mean when a person unintentionally comes to rest on the ground or another lower level.
  • If you fell in the past 3 months:
  • (By injury we mean the fall caused you to limit your regular activities for at least a day or to go see a doctor.)
  • How sure are you that you can do the following activities?
  • Thank you for completing the Tai Chi for Arthritis First Session Survey