Membership – Start Here2018-07-05T10:11:50+00:00

L.I.F.E! - Membership Starts Here

Get Started with our Health Survey

Upon submission you will be taken to our registration page to create your username and password.
IT'S FREE!


Address of Household (req.)

Names of Members of Household






 


Complete your LIFE! HEALTH SURVEY

The information you share is strictly private, protected by HIPPA regulations. It is used for the purpose of showing progress on LIFE membership health initiatives to provide aggregate data as required by our grant funding partners.


 
In general, how would you rate your physical health? (req.)

To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs or carrying groceries? (req.)

In the past 7 days, how would you rate your fatigue on average? (req.)

Indicate the number of meals you eat away from home during a week: (req.)

On an average day, how many servings of vegetables and fruits do you eat? (req.)

On an average day, indicate which drink you consume the most? (req.)

How many times do you exercise for a minimum of 30 minutes in a week? (req.)

What type of exercise do you participate in most often? (req.)

Other forms of exercise?

How many hours during an average night, do you get a good/restful sleep?(req.)


 
Please complete if you are joining to support a Group or Organization.


 


 


take our survey and JOIN LIFE

Thank you for completing our survey. Your information is HIPPA protected, all data is aggregated so no personal information is attached to it - no worries!

Your survey is valuable to us because it will be combined into a community health report card.

Our report card allows us to show our grant funders that we are making progress and their investment is contributing to important work.

Better report cards mean more opportunities to enjoy healthy living!

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LCHAT is officially a 501(c)3, non-profit organization.