Wellness Survey Form
1. Are you currently participating in a wellness and/or exercise program?
2. Do you feel tired often?
3. Are you getting 7-8 hours of sleep each night?
4. Do you feel stressed more than once a week?
5. Describe your current health status.
6. Do you have any chronic pain?
7. Do you have any chronic illness or on prescription medication?
8. Describe your daily activity level.
9. Describe your current eating style.
10. Do you want to lose weight?
11. Are you interested in learning how to prepare quick and healthy meals?
12. Are you interested in increasing your activity level through exercise?
13. Are you interested in improving your overall health and wellness?
14. What exercise formats are you interest in?
Click all that apply.
