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  2. 2014
  3. October
  4. H
  5. Health & Wellness Questionaire
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Exit Survey
 
 
If You Had a Health & Wellness Center or Community Local to You Would You Go?
 
Yes
 
No
 
Maybe
 
 
How Often do You Use the Following Products?
Don't Use Daily Weekly Monthly Quarterly
Anti-Aging Creams
Supplements
Energy Drinks
Pet Supplements
Air Purifiers
 
 
Tell us More About the Products You Use Above:
   
 
 
 
What Would You Want to See at The Health & Wellness Center?
 
Yoga
 
Group Training
 
Nutrition Education/Product Knowledge
 
Mind & Body Enpowerment
 
Private Mentoring
 
Health Professional Events
 
Other
 

 
 
 
How Would You Rate the Overall Satisfaction With Your Health?
 
Highly Satisfied
 
Somewhat Satisfied
 
Neutral
 
Somewhat Dissatisfied
 
Highly Dissatisfied
 
 
Comment:
   
 
 
What Are the Most Important to You?
No Interest Think About it Somewhat Important Important Very Important
Exercise
Nutrition
Mind & Boby
Your Health Condition: If You Want to Tell us Your Condition You May ______________________________________
Naturopathic
 
 
Comment:
   
 
 
 
How Likely Are You to Move on Your Interests into a Healthier Lifestlye?
 
Very Likely
 
Somewhat Likely
 
Neutral
 
Somewhat Unlikely
 
Very Unlikely
 
 
 
If You Found Something Great Would You Share it With Others?
 
No
 
Yes
 
Maybe
 
 
 
What is the Likelihood You Would Change Your Lifestyle Today For a Healthier You?
 
High
 
Somewhat High
 
Not Sure
 
Somewhat Lower
 
Lower
 
NOT
 
 
 
Do You Have Any Ideas to Improvement Yourself?
   
 
 
 
What is Your Gender?
 
Male
 
Female
 
Prefer Not to Answer
 
 
 
Which of the Following Categories Describes Your Age?
 
Younger Than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer Not to Answer
 
 
 
What best describes your employment status?
 
Employed full-time
 
Employed part-time
 
Self-employed
 
Unemployed, Looking for work
 
Unemployed, not Looking for Work
 
Student
 
Retired
 
Military
 
Professional Homemaker
 
Prefer Not to Answer
 
Other
 
 
 
 
Which Category Best Describes Your Annual Income?
 
Under $15,000
 
$15,000 - $29,999
 
$30,000 - $44,999
 
$45,000 - $59,999
 
$60,000 - $74,999
 
$75,000 - $89,999
 
$90,000 or more
 
Prefer Not to Answer
 
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