First and Last Name *

First Name

Last Name

Phone

(###)

###

####

1. How many employees work at your company?

1-5

6-25

26-50

51-100

100+

2. Who in your company is responsible for employee benefits?

I am

HR Manager

Office Manager

Other

3. Does your company currently offer a wellness program?

Yes

No

I'm not sure

Not yet, but I want one

4. Check the following workshop topics that interest you.

Create the Time for You

Eat for Energy

Get moving!

Sleep your way to a productive day

Stress less and calm the mind

Prep and plan ahead for success

6. What is the ideal length of time for a wellness workshop?

45 minutes

1 hour

1.5 hours

2 hours

Other

7. How often would you be interested in a wellness workshop?

Monthly

Quarterly

Biannually

Annually

8. How much are you willing to invest per year towards improving company wellness?

Under $500

$500-$1,000

$1,000-$2,000

$2,000+

9. What times of the year would be ideal for a wellness workshop?

Q1: January-March

Q2: April-June

Q3: June-September

Q4: October-December

10. How many workshops would you be interested in per year?

1

2-3

4-6

6+