Wellness Survey

Signal Health Group

Wellness Survey Form

Signal Health Employee Wellness Survey

1. Are you currently participating in a wellness and/or exercise program?

YesNoOther

2. Do you feel tired often?

YesNoOther

3. Are you getting 7-8 hours of sleep each night?

YesNoOther

4. Do you feel stressed more than once a week?

YesNoOther

5. Describe your current health status.

In good healthIn average healthIn poor healthOther

6. Do you have any chronic pain?

YesNoOther

7. Do you have any chronic illness or on prescription medication?

YesNoOther

8. Describe your daily activity level.

InactiveModerately activeVery activeOther

9. Describe your current eating style.

Mostly fast foodI eat healthy food 2-3 days a weekI eat healthy food during the week and splurge on the weekendsI eat healthy every day of the week and rarely splurgeOther

10. Do you want to lose weight?

YesNoOther

11. Are you interested in learning how to prepare quick and healthy meals?

YesNoOther

12. Are you interested in increasing your activity level through exercise?

YesNoOther

13. Are you interested in improving your overall health and wellness?

YesNoOther

14. What exercise formats are you interest in?

Click all that apply.

Body Weight StrengthWorkouts at home with equipment (dumbbells, bands, kettlebells, balls, bar, etc.)Workouts at a gym with equipment (dumbbells, bands, kettlebells, balls, bar, etc.)High Intensity Interval TrainingWalkingJoggingHikingCyclingDanceYogaOther