Wellness Program Survey

Northland Health Centers are excited you have chosen to be part of the Wellness Program!
This challenge was designed to encourage overall wellness, consistent physical activity, and healthy diet choices. We hope you find this to be a fun experience for developing positive lifestyle changes.

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* 1. What is your name?

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* 2. Prior to the challenge, approximately how many minutes of exercise do you do daily? *continuous; not including housework*

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* 3. Prior to the challenge, approximately how many servings of fruits and/or vegetables do you consume daily?

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* 4. Prior to the challenge, approximately how many hours of continuous sleep do you get on a typical night? 

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* 5. Prior to the challenge, approximately how many ounces of water do you consume daily?

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* 6. What is your eight-week personal goal for the wellness challenge?

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* 7. What could this challenge do to help you reach your wellness goal?

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* 8. What is your email address?

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