Kirk Healthy Lifestyles Group Buddy System Are you interested in a buddy or accountability system to help you meet your healthy lifestyle goals? If so, please fill out and submit this questionnaire. Would you prefer a duo, group or partner?* Duo (you & one other who have compatible goals & personalities) Group (three or more with compatible goals) Partner (spouse or significant other) What type(s) of interaction would you prefer?* Face-to-face Phone Electronic (email, txt'ing, facebook, twitter...) Online tracking system How often do you want to interact?*WeeklyBi-weeklyMonthlyAs neededWhat goal would like this buddy system to address? (You can fill out more than one questionnaire if you want to address different goals by different buddy/accountability methods.)What are your top 3 expectations of a buddy system? Please rank 1-3ListWalking or workout activitiesEncouragement & motivationInfo sharing on topics of interestOther (describe below) Other descriptionName* First Last Fill in one or both contact methods.Email PhoneAny additional information you would like to provide.