Welcome to CHIP!
start
 
CHIP is an intensive, 9 week lifestyle intervention class. Before we begin, we'd like to check in with you about your hopes for the course. Take as much time as you'd like to, but please make an effort to fill this in as completely as your schedule allows. This will help us deliver the best class that we can!

 
Name *

 
How are you feeling about starting CHIP? *


 
What are you hoping to get out of CHIP? This can be about more than your numbers (cholesterol, weight, etc.), although it doesn't have to be. Perhaps you want to form connections with others who are trying to live their healthiest lives, play with your grandchildren without getting winded, or reduce your heartburn. Feel free to write in a stream of consciousness or bullet points. *

 
What percentage of your diet would you consider to be plant-based? (A plant-based diet is one that is based on whole plant foods, including vegetables, fruits, whole grains, legumes, nuts and seeds. As the name implies, it is a diet with plant foods as th

 
Currently, my diet is about ___% plant based.


 
How many days per week are you usually physically active?


 
Which test result(s) are you most concerned about, if any? *


 
Everyone has something they need some extra help with. How can we best support you? Maybe you need some extra cooking tips, or some help learning to stock your pantry for a plant based diet. Perhaps you need help finding a primary care physician or an exercise accountability buddy in the group. It's okay if you don't know what you'll need yet-- you can just tell us how you'd like to be supported. *

 
Is there anything else you would like to tell us?

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