NFP P&C - Lapre Scali Wellness Survey

Lapre Scali Wellness Survey

Location #: Gender:

We need this in order to choose activities for specific locations.

Personal Goals & Preferred Areas of Interest
Take a moment to think about your personal goals for your health. Please review the list of areas of interest below and check all that apply:
Reducing blood pressure
Reducing cholesterol
Management of blood glucose
Weight management
Strength training
Healthy mind & body
Work life balance
Stress management
Quitting tobacco
Physical activity
Depression
Anxiety
Nutrition
Reduction of illness and injury
Other:

Activities
Using your answers from above, please answer the following questions about activities you would be interested in participating in. Select all that apply:
Weekend Physical Fitness Days
Group Walk-A-Thon
Lunch and Learn about Nutrition
Biggest Loser competition
Personal Training
Meditation
Massage
Healthy Recipe Competition
Counseling
Meeting with a Nutritionist
Biometric Screenings
Other:

Incentives
Because these activities are completely voluntary, what types of incentives would best encourage your participation and the participation of others. Select all that apply:
Cash incentives
Lunch
Gift cards
Group Discounts
Big Giveaway (i.e. trip)
Fun Activities such as bowling, etc
Additional time off
Recognition from peers

Toll Free: 1-877-995-2773 (1-877-99-Lapre) | Bond Dept: 1-800-863-3210 | Fax: (480) 947-6699