Employee Wellness Consulting Pre-assessment Form
Please complete this brief pre-assessment to help us understand your current wellness experience at work. All questions are non-sensitive and designed for a general wellness consultation.
Full Name
*
First Name
Last Name
Work Email Address
*
example@example.com
Department / Team
*
Current Role or Position
*
How would you rate your overall well-being at work?
*
1
2
3
4
5
How satisfied are you with your current work-life balance?
*
1
2
3
4
5
Which of the following wellness areas are you most interested in improving?
*
Physical activity
Nutrition
Stress management
Sleep quality
Social connection
Other
What challenges or barriers do you experience in maintaining your wellness at work?
*
Which of the following wellness program formats do you prefer?
*
Individual coaching
Group workshops
Online resources
Self-paced challenges
Other
What is your primary goal for participating in a wellness program?
*
Do you have any suggestions or preferences for future wellness initiatives?
Submit Pre-assessment
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