support of others contributes to longevity
W •
WHEN: (insert appropriate day/date)
form below, enclose in an envelope and
and well being.
•
WHERE: (insert place)
mail back to us at the address listed on the
•
TIME: (insert hour)
front of this brochure. The few minutes
modifications, including dietary and weight management, exercise and conserving energy, smoking cessation and reduction of excess
you can move forward with a program that serves your best interests.
ABOUT OUR SUPPORT GROUP LEADER.
fluids; pharmacological information; and emotional well-being.
(Insert a brief bio of your selected leader).
❒ Yes, please sign me up for the CHF Support Group, and notify me of the next meeting.
basic needs as a CHF patient: lifestyle
experiences so that
❒ Yes, I am interested in interested in learning more about the CHF Support Group. Please call me at the above number.
Our goal is to help you with some of your
and physical
Please make your selection:
support person to attend with you.
common emotional
E-mail address: ______________________________________________
You may want to invite your spouse or
disease and share
) ______________________________________
spiritual wellness and much more.
Faxsimile Number: (
learn more about your
big, positive difference in your life.
) ______________________________________
a low-sodium diet, financial planning,
you take to fill out this form can make a
(
Group will help you
about the program, just complete the
Phone Number:
diverse topics as keeping fit, dining out on
group, or would like more information
City, State, Zip: ______________________________________________
We hope that our CHF Support
f you would like to join our support
Address: _____________________________________________________
The CHF Support Group will be led by (insert name). We hope to address such
I
basis as follows:
Name: ______________________________________________________
Support Group. It is our belief that the
e will meet on a monthly
PATIENT REPLY FORM
failure, you are invited to join our CHF
THE DETAILS
CHF SUPPORT GROUP: AN INVITATION
I
f you experience congestive heart