Journey to Health TV Airs on the Belfast Public Access channel, Thursdays at 7:00 pm
Under the guidance of our personal trainer, Mirja Pitkin, we will be offering an opportunity to do beginner exercises together each week. Your responses to this questionnaire will help us plan an exercise class that is appropriate for all participants.
Please wear clothes you can exercise in and bring a water bottle. Shoes are not necessary for this class (unless you have foot or arch concerns, in which case please carry in a pair of clean sneakers).
Please complete this form and return to Hester Kohl as soon as possible. We will need this no later than one week before your first class. You can e-mail it to email@example.com, fax it to 930-2569, drop it off at the hospital switchboard, or mail it to: Hester Kohl, WCGH, PO Box 287, Belfast, ME 04915.
Your name: _____________________________
Phone number: __________________________
1. Do you have old injuries or chronic issues with any of the following (circle yes or no). If yes, please explain briefly?
Feet: Yes No ___________________________________________________
Ankles: Yes No ___________________________________________________
Knees: Yes No ___________________________________________________
Hips: Yes No ___________________________________________________
Back: Yes No ___________________________________________________
Shoulders: Yes No _________________________________________________
Neck: Yes No _____________________________________________________
Wrists/elbows: Yes No _______________________________________________
Hands: Yes No _____________________________________________________
Do you have any other physical conditions/issues you think could impact your participation in an exercise program?
Yes No ___________________________________________________________
2. Exercise history. Please briefly list exercise programs you have participated in, when that was, if you enjoyed it, and why you stopped, if you did.
3. What are you goals for participating in this program?
1 pound Yukon Gold potatoes, peeled and cut into 1½ inch chunks
1 pound sweet potatoes, peeled and cut into 1½ inch chunks
½ cup low-fat milk
2 tablespoons butter
1 teaspoon brown sugar
¾ teaspoon salt
¼ teaspoon freshly ground pepper
Place potatoes and sweet potatoes in a large saucepan and add enough water to cover. Bring to a boil over high heat and cook until very tender when pierced with a fork, 20 to 25 minutes.
Drain the potatoes, then mash them in the pot to the desired consistency. Place milk and butter in a small bowl and microwave on high until the butter is mostly melted and the milk is warm, 30 to 40 seconds (alternately, place in a small saucepan and heat over medium until the milk is warm). Stir the milk mixture, sugar, salt and pepper into the mashed potatoes until combined.
Makes six servings, about 2/3 cup each, 151 calories