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  5. WELLife Exit Survey
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Exit Survey
 
 
Hello:
You are invited to participate in our exit survey based on your participation in our program, WELLife. This survey will ask questions about the health aspects covered in the program. It will take approximately 10-20 minutes to complete the questionnaire.

Your participation in this exit survey is completely voluntary, however your feedback is valuable and will help to improve our program for the future. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Elizabeth Sittig at 555-555-5555.

Please submit the survey by November 12, 2013 by 11:59 pm Central Time.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
After completing this program, how often are you likely to engage in physical activity during a typical week?
 
Never
 
Once a week
 
2-4 days a week
 
5 to 7 days a week
 
 
 
After completing this program, how long do you expect your workout duration to be on a typical day?
 
Not sure
 
0-30 minutes
 
30-60 minutes
 
60 or more minutes
 
I won't work out
 
 
 
After completing this program, how often will you cook at home?
 
Never
 
Once a week
 
2-4 times a week
 
5-7 times a week
 
 
 
After completing this program, which food groups are you going to incorporate more into your daily diet?
 
Fruits
 
Vegetables
 
Grains
 
Dairy
 
Meat and Poultry

 
 
 
After completing this program, how many times a week will you use stress management techniques?
 
Never
 
Once a week
 
A few times a week
 
At least once a day
 
 
 
After completing this program, which types of stress relief activities do you think you will engage in?
 
Exercise
 
Yoga or Meditation
 
Watch T.V. or Listen to Music
 
Read
 
Power Nap
 
Visualization Exercises
 
I won't engage in stress relief activities
 
Other (please specify)
 

 
 
 
After completing this program, which workshop was your favorite?
 
Fitness
 
Nutrition
 
Stress Management
 
Social Health
 
 
 
After completing this program, which workshop do you think needs improvement?
 
Fitness
 
Nutrition
 
Stress Management
 
Social Health
 
None, all were great

 
 
 
Your feedback is greatly appreciated. Please feel free to leave any type of Comments/Suggestions: