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2021 Convention
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Follow-Up Survey
This survey will take approximately 7 minutes to complete and will help us assist you and our other guests with the transition from our program. Please answer the following questions as thoroughly as possible.
*
Indicates required field
Name
*
First
Last
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Date of Birth
*
Who was the Eden Valley physician during your session?
*
Select a physician
Harold Cherne, MD
N. David Emerson, MD
John Clark, MD
Kieth Schleifer, MD
Session you attended
*
Select session month
January
February
March
April
May
June
July
August
September
October
November
December
Select One
*
Select session year
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
What health conditions did you want to address while at Eden Valley Lifestyle Center?
*
Has your condition/health concern improved?
*
Yes
No
Have you been hospitalized since leaving EVI?
*
Select a response
Yes
No
Not Sure
Is the Eden Valley program still helpful to you
*
Yes
No
Not Sure
How much of the Eden Valley program have you continued?
*
None
25%
50%
75%
75% or more
How are you feeling, on a scale from 1-10 (1 being poor and 10 being mostly well)?
*
1
2
3
4
5
6
7
8
9
10
Current Symptoms (select any that apply)
*
Fever
Pain
Insomnia
Headache
Depression
Increased Stress
Decreased Stress
Weight Gain
Weight Loss
Other
What other symptoms are you experiencing?
*
Questionnaire Complete
HOME
ABOUT US
2021 Convention
LIFESTYLE
Success Stories
Lifestyle Program
One Day Retreat
Program Dates
Rates and Payment
Follow-Up Form
Application Form
COVID-19 Protocol
EDUCATION
Medical Missionary / Evangelism
Agricultural Program
COUNTRY STORE
CONTACT
FARM
Farm Store
MEDIA
Photo Gallery
2017 Convention
2018 Convention
Faith Ventures
Volunteer Opportunities
FORMS
Volunteer Application
Student Application
Agricultural Student Application
Reference Form
DONATE
Volunteer Application
ASI Weekend Rally
