Integrating Primary Care Practices and Community-based Resources to Manage Obesity: A Bridge-building Toolkit for Rural Primary Care Practices

Tool 8. Sample Community Inventory Form

Name of Organization: Basic Yoga Studio

Address:
Phone:
FAX:

Email:
Website:
Primary Contact Person:
 

Availability—Program Description—Purpose or Mission Statement Included: Therapeutic Yoga. "Do No Harm."

Description of Typical User: People who want to make a change in their life and are willing to be responsible for and committed to their health needs.

Accessibility—Hours of Operation: 

Basic Yoga (for new and returning students): Tuesday and Thursday: 10-11:15 am and 6-7:15 pm.
Gentle Basic Yoga (student specific, modified poses): Tuesday and Thursday: 3-4:15 pm.
Private instruction is available.

Physical Barriers: Stairs.

Affordability—Fee (Cost)—Including Potential Discounts for People We Refer– Scholarships:

10 classes for $80
10 classes for $75 for seniors over 55 years
Drop-in fee: $10/class

Accepted Insurance: None.

Continuity—Funding source, years in operation: Client funded. Instructor has been teaching in area since 2001.

Quality—Evidence of Effectiveness: Some clients are referred by their physician and by word of mouth. Classes continue to be full. There is scientific evidence supporting the benefits of yoga on health.

Methodological Approach: Clients receive instruction and then are expected to perform.

Feedback—How will organization let clinics know the client has been served?

Basic Yoga Studio is willing to fill out any appropriate forms, although must be client initiated due to HIPPA concerns.

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Current as of May 2014
Internet Citation: Integrating Primary Care Practices and Community-based Resources to Manage Obesity: A Bridge-building Toolkit for Rural Primary Care Practices : Tool 8. Sample Community Inventory Form. May 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/improve/community/obesity-pcpresources/obpcp-tool8.html