Wellness Survey

Thank you so much for taking the time to fill out this survey. Your feedback is incredibly helpful for us, and will hopefully lead to exciting new programs for you! Please note that there are 4 pages of questions and a final thank you page. The whole thing should take only a few minutes. Please answer all of the questions.

Health Goals



Eating healthy
Exercising
Managing stress and relaxing
Going to the doctor regularly
Following through on my doctor’s recommendations on prescriptions/procedures (when applicable)

Eating healthy
Exercising
Managing stress and relaxing
Going to the doctor regularly
Following through on my doctor’s recommendations on prescriptions/procedures (when applicable)




Not at all confident Very confident