Health Survey

Hello,

You are receiving this survey because you are part of the Company Gym Membership Program. In an effort to learn how the program is working for you, and in anticipation for the company function on healthy lifestyles, we are asking you to share with us your experience. (No names will be used.) Please only answer the questions with information you feel comfortable sharing.

Thanks!

Prior to joining the Company Gym Membership Program, I...

Did not belong to a gym.

Attended a gym.

Since you attended a gym prior to the company offering a gym membership, check the box that applies?

I was working out less than eight times a month.

I was working out at least eight times a month.

I joined the Company Gym Membership Program to…

Reduce Blood Pressure

Reduce Cholesterol

Lose Weight

Get in Better Shape

Since joining the gym, my blood pressure has...

Improved.

Has not changed yet.

What is your old and new blood pressure reading:

Since joining the gym, my cholesterol has...

Improved

Has not improved yet.

How many point has your cholesterol improved?:

Since joining the gym, I have?

Lost weight.

Not lost any weight yet.

How much weight have you lost?:

What percent has your body fat decreased by? If you don't know, just leave blank:

Answer all that apply:
Since joining the Company Gym Membership Program...

I have more energy.

I have more flexibility.

My body is becoming more toned.

I am eating healthier

I sleep better.

I feel less stressed.

My muscle mass has increased.

I feel healthier overall.

If you would like to make a comment about your experience or share your improvement, please use the space below: