Student Wellness Treatment Selection Survey
Please complete this survey to help us understand your wellness treatment preferences and needs.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Wellness Treatment Type
*
Please Select
Meditation
Yoga
Counseling
Physical Therapy
Nutritional Counseling
Other
Specify Other Treatment Type
Have you undergone wellness treatments before?
*
Yes
No
Current Stress Level
*
Please Select
Low
Moderate
High
Very High
Symptoms or Concerns (Select all that apply)
Anxiety
Depression
Sleep Issues
Physical Pain
Lack of Energy
Other
Specify Other Symptoms or Concerns
Importance of Wellness Treatment
*
1
2
3
4
5
Submit
Should be Empty: