Initial Consultation Question Title * 1. Company Information Your Name & Title Company Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 2. Do you currently have a Wellness program in place? Yes No In the process of creating a program. Other (please specify) Question Title * 3. If you answered yes to the above question, please select the programs that you've implemented for the employees. (Check all that apply) Nutrition & Cooking Demos Time & Stress Management Workplace Ergonomics Understanding Your Insurance Benefits Financial Wellness Wellness Days Smoking Cessation Bio-metric Testing (i.e. Blood Pressure, cholesterol check, etc.) Other (please specify) Question Title * 4. Does your company sponsor any outside events or non-profit organizations? (If yes, please list them in the "other" section) Yes No Other (please specify) Question Title * 5. If you answered no to the above question but are interested in receiving more information on this, please select any or all of the below organizations that you would like to know more about. The Salvation Army The YMCA Young Women's Breast Cancer Awareness Foundation Cystic Fibrosis Foundation American Heart Association Catholic Hospice Brother's Brother Foundation Greater Pittsburgh Community Food Bank Venture Outdoors/Kayak Pittsburgh Pittsburgh Downtown Partnership Question Title * 6. Please select from the following options as it would pertain to your company's involvement with a non-profit entity. (Select all that apply) Sponsorship Volunteer services Done
