Community Wellness Interest Survey

1. What is your age range?

What is your age range? Under 50

50-59

60-69

70 and Up

2. Where do you get most of your information on taking care of your health and wellness?

Where do you get most of your information on taking care of your health and wellness? Doctor

Family/Friends

Caregivers

Books/Magazines

Newspaper

Internet

Other

3. If you do not currently belong to a wellness/fitness center, what keeps you from incorporating this into your daily routine?

If you do not currently belong to a wellness/fitness center, what keeps you from incorporating this into your daily routine? Intimidation of others that are at the facility

Too busy

Don't know how to use the fitness equipment

Don't want to go by myself

Lack of interest

Lack of motivation

Other

4. Please select the areas of wellness you are MOST interested in having offered to you:

Please select the areas of wellness you are MOST interested in having offered to you: Physical(i.e., exercise classes, fitness, health screenings)

Nutrition (i.e., healthy cooking classes)

Emotional (i.e., support groups, stress management, massage, etc.)

Spiritual (i.e.,yoga, Tai Chi, mindful exercise

Vocational (i.e., volunteer work, learning new skills, job search/skills)

Social (i.e., clubs, travel, networking)

Intellectual (i.e., educational/cultural classes, reading groups, games/puzzles)

5. What time of day would you prefer to exercise or attend programs?

What time of day would you prefer to exercise or attend programs? Morning

Afternoon

Evening

6. Which type of wellness program would you be most interested in attending?

Which type of wellness program would you be most interested in attending? Educational programs pertaining to wellness

Independent use of fitness resources

Group classes led by an instructor

7. How often would you most likely utilize a wellness center?

How often would you most likely utilize a wellness center? For occasional programs only

Monthly

Weekly

Several times per week

Not at all

8. How much assitance would you expect from a wellness center and its staff?

How much assitance would you expect from a wellness center and its staff? Limited - just general orientation

Moderate guidance from staff about the available programs

Assistance only with specialized classes and programs

Ongoing skilled assistance from a fitness instructor or expert in the program area

9. What is one program or service that you would MOST like to see offered at the Three Pillars Wellness Connection?

What is one program or service that you would MOST like to see offered at the Three Pillars Wellness Connection?

10. Thank you for your time and participation.
If you would like to be entered in the drawing for a Pick n Save gift card, please provide your name and address below:

Thank you for your time and participation. If you would like to be entered in the drawing for a Pick n Save gift card, please provide your name and address below:

Community Wellness InterestExit this survey

Wellness Interest Survey