Thank you for participating in the Civilian Health Promotion Program. Please answer the following questions about your participation, and add any additional comments you wish to make. Your answers and comments will be extremely helpful in making improvements for future programs in this and other commands. Please send this form to_________________. All responses will be kept confidential unless you specify otherwise. Thank you for your help in making the Civilian Fitness Program the best it can be!

1. Did you reach your goal(s) for improvement? Explain. If applicable, please give examples of number of pounds or % Body Fat lost, number of points your cholesterol dropped, etc.

• Did you decrease your body fat percentage? _________ If so, how much? _____________
• Did you lose weight? _________ If so, how much? ______________
• Did you quit smoking? _________ If so, what method did you use? ___________________
• Did you begin a cardiovascular program? ________ A strength training program? _______
  If so, what are you presently doing? _______________________________________
• Did you develop skills to manage the stress in your life? _________
  If so, how? _________________________________________________________________
• Did you adopt healthier eating habits? _________
  If so, did you lower Cholesterol? ________ By how many points ___________________
• Did you see any changes regarding your Blood Pressure? ________
  If so, what? _______________________________________________________________