Saint Boniface Parish is in the process of forming a Health and Wellness Ministry.  The members of this ministry would function as: Health educators, advocates, consultants and liaisons to community resources.

 

Health & Wellness Ministry

Needs Assessment Form

Number of people living in your household:    

Ages:   

We would like to know which of the following needs that you or someone in your family has experienced that you feel are not being adequately met either by the parish or by the community. (Check all that apply)

I need help with:

Transportation

    To doctor
    To food store
    To church
    To job
    To senior citizen center
Other   

 

Meals / Home Maintenance

    Meal preparation
    Food stamps
    Baby formula and food
    Meal-on-wheels
    Home and Yard Maintenance
    Food pantry
Other   

 

Legal / Financial

     Filling out insurance forms
    Social Security
    Medicare / Medicaid information
    Living will / Health Proxy /Power of Attorney
    Preparing / updating will
    Preparing a budget
    Financial advice
    Locating a job

 

Health Care

     Physician / clinic
     Medical care
     Mental health care
    Prenatal care
    Dental care
    Help with sick or disabled person
    Help with elderly person
    Medication preparation
    Blood pressure monitoring
    Phone buddy for elderly person living alone
Other   

 

Spiritual Well - Being

    Receiving the Eucharist at home
    Obtaining home visits from pastoral visitor or other parishioner
    Refresher or reintroduction to the Catholic faith

 

Support Networks

I would be interested in a support group for:
     Alcohol abuse
    Drug abuse
    Child abuse
    Family abuse
    Divorced persons
    Widowed persons
    Suicide
    Caregivers of the disabled
    Jobless
    Mentally ill
    Developmentally disabled
    Chronically ill
    Physically disabled
    Grief
    Caregivers of elderly
Other   

 
I would be interested in or have need for information on these services:
     Hospice
     Child day care or latchkey programs
     Mental health resources
    Nutrition
    Family counseling
    Safe home for battered women
    Nursing Home Placement
    Home Health Care / Long Term Care
    Health-related issues such as diet, stress, exercise, smoking cessation, etc.
Other     		Are there other areas where you or someone in your family have experienced a need that you feel has not been adequately addressed?   

        Please press "submit" to transmit this needs assessment form to our Health and Wellness office to assist us in determining what needs must be met.  If you have any of the unmet needs from the above lists or any other unmet need that you would like to discuss personally with a nurse from the Health and Wellness Ministry, please complete the section below or call the Parish Center at 516-676-0676. 

[In addition to completing and submitting the above survey, you may, if you wish, complete the following form , if you desire personal contact with our ministry]

Name:     

Street Address:   

Town:  

Home Phone:   

Work Phone:   

email address:   

Please have a representative contact me.   

I would be interested in assisting with the Health and Wellness Ministry.   

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