Better Together Support Group Inquiry Form
Contact Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Is this a cell phone?
Is it okay if we text you?
What's the best way to contact you?
Phone
Email
What are your health concerns?
(Please select all health concerns that apply)
Anxiety/Depression
Arthritis
Diabetes
High Cholesterol
Hypertension (High Blood Pressure)
Weight
Other
What would you be interested in learning more about?
(Please select all interests that apply)
Blood pressure management
Cholesterol management
Diabetes management
Exercise (and help developing an exercise program you can do at home)
How to better access health care information (and improve online computer skills)
How to communicate effectively with others about your health
How to handle the side effects of chronic illness (such as fatigue, depression, and frustration)
How to make better food choices
How to relax/meditate
How to use medications properly
Weight management
Other
Please let us know if you have any questions:
Submit
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