Enrollment Survey - Concentrate on Resilient Energy Program

Welcome to the C.O.R.E. (Concentrate on Resilient Energy) program! Thank you for taking an active role to boost your mind, body, and spirit. To get the most out of this program, we’ll need some basic info to personalize the content we send you. We want you to know that all information shared and received in our program is confidential. Your information will not be shared or used for any other purpose. If you want to check the terms and conditions, just tap here. But if you want to boost your strength, find your zone, and maybe some inner clarity—let’s get started.

First Name:*

(We only need this information to personalize your content.)

Mobile Number:*

(We only need this information to send you wellness text messages.)

Are you on active duty, are you a Veteran, or are you a Retired Veteran?*

Veteran/Retired Veteran
Active

How long have you been out of the military?*

How long have you served in the military?*

How old are you?*

It’s important to set goals to better your mind, body, and spirit. What is one wellness goal you have for yourself?*

Are you experiencing any of these life changes right now? If so, please select the biggest life change you are going through:*

Moving
Relationship ending
Relationship starting
Becoming a parent (for the first time, or again)
Grief
Injury or illness
Changing jobs
No big changes right now

Which of these topics could you use help with?*

(Please select all that apply.)

Substance use
Smoking/vaping cessation
Insomnia
Acute stress
Chronic stress
Parenting
General health and well-being

On a scale of 1 - 5, please rate your level of acute stress and anxiety today.*

(1 = no stress, 5 = high stress)

On a scale of 1 - 5, please rate your level of chronic stress and anxiety today.*

(1 = no stress, 5 = high stress)

Terms and Conditions*

The Telephone Consumer Protection Act generally requires us to obtain consent before contacting people on their mobile phones. By enrolling in this program, you are granting consent to GoMo Health to contact you via text message to the number you are enrolling with from the number 43386. You may get up to 1-2 messages per week. Please note that depending on your mobile phone service plan, message and data rates may apply according to your mobile provider. You also confirm that you are the wireless subscriber or owner of the mobile number provided and have the authority to provide consent. For help with the text program, please text HELP to 43386. You may opt-out at any time by replying STOP or STOPALL to 43386. To unsubscribe from emails, click ‘unsubscribe’ at the bottom of any email you receive. Terms & Conditions can be found at https://core.gomohealth.care/. GoMo Health Privacy Policy can be found here: https://gomohealth.com/privacy/.

I have fully read and agreed to the terms and conditions of this program.
 I have completed the enrollment form, provided electronic consent to enroll, and I grant permission to GoMo Health to contact my cell phone via text message from the phone number 43386.