Skip to content
OhioGuidestone Research Portal
Home
About
Media Release Forms
Joyful Together®
Joyful Together® Follow-up
Father’s Feelings
Fathers Feelings Follow-up Interview Study
CareSource Project Forms
The Maternal Vitality Study
Maternal Vitality Study- For Women/Mothers
MVS Clinician Form
Staff Forms
PFS-2-Staff
Staff Joyful Together® Fidelity Tool
Supervisor Fidelity Process Guidance Tool
Clinical Note
Intervention Note
Closing Note
Student Intern Evaluation Projects
Initial Intern Evaluation Project Information Form & Agreement
Updated Intern Evaluation Project Form
Search for...
OhioGuidestone Research Portal
Toggle Navigation
Toggle Navigation
Home
About
Media Release Forms
Joyful Together®
Joyful Together® Follow-up
Father’s Feelings
Fathers Feelings Follow-up Interview Study
CareSource Project Forms
The Maternal Vitality Study
Maternal Vitality Study- For Women/Mothers
MVS Clinician Form
Staff Forms
PFS-2-Staff
Staff Joyful Together® Fidelity Tool
Supervisor Fidelity Process Guidance Tool
Clinical Note
Intervention Note
Closing Note
Student Intern Evaluation Projects
Initial Intern Evaluation Project Information Form & Agreement
Updated Intern Evaluation Project Form
DaddYoga Pre Survey
Return to Main DaddYoga Page
DaddYoga Survey Study: Pre Survey
This form is for fathers participating in the DaddYoga Survey Study. Fathers should complete this form one time before starting a DaddYoga series between July-December 2022.
Please enable JavaScript in your browser to complete this form.
Date / Time
Date
Time
Father's Name
*
First
Last
Note: We will remove your name and replace it with a de-identified Study ID number to add privacy.
This is my first time doing yoga.
Yes
No
How are you feeling? (check all that apply)
Depressed
Upset
Tired
Neutral
Relaxed
Excited
Joyful
How do you feel about participating in Daddyoga? (check all that apply)
Depressed
Upset
Tired
Neutral
Relaxed
Excited
Joyful
I think DaddYoga will help:
Improve how my body feels
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Improve my thoughts, feelings and actions
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Understand or identify my emotions
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
To manage my stress
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
To understand that body, thoughts, feelings and actions are connected
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
To express my emotions safely
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
My relationship with my child
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
My relationship with my family
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
My spiritual/religious beliefs
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
My confidence in myself
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
My confidence as a father
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I think DaddYoga sessions will:
Be a safe place to express my emotions
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Be a positive environment for fathers
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I think DaddYoga will teach me:
That being a father is being a leader
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
The importance of using good communication skills with my co-parent (ex. mom of baby)
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
How to improve my general communication of my thoughts and feelings
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Ways to positively impact my family
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
About being a Cycle Breaker
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
How to break negative or harmful cycles in my family
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
That I can create, or keep, new and positive cycles in my family
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Would you tell other fathers about DaddYoga?
Yes
No
Is there anything else you want us to focus on during DaddYoga?
Submit