Progress Survey

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PROGRESS SURVEY

Name

How long have you been participating in adaptive programming with B-Bold?

I am brand new

1-3 months

3-6 months

6-12 months

1-3 years

Please select the outcomes of interest to you: (Select all that apply)

Improve function for daily tasks

Improve fitness

Weight loss

Decrease pain

Meet new people/socialize

Improve ability to compete/sports competition

Job skills

Other

On a scale from 1-10, please rate the following items for you or the participant.

Physical Shape

Sociability

Mood

Confidence

Please provide any additional details about your goals for the program and if you have achieved them. Feel free to include any information about how you are feeling about the adaptive programming.

Thanks for submitting!

CONTACT

CALL OR EMAIL IF YOU HAVE MORE QUESTIONS

bboldrustin@gmail.com
970-237-0397

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