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* 1. What is the current level of stress and/or pressure you feel overall in your life? (Select the statement that best applies to you.)

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* 2. Is improving your quality of life and/or avoiding burnout a priority for you?

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* 3. Which of the following areas that may enhance your quality of life are you most interested in learning more about or doing more? (Select all that apply.)

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* 4. Which of the following areas are of least interest? (Select all that apply.)

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* 5. How do you feel about the term “wellness”? (Select all that apply)

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* 6. What are your current or preferred sources of information to learn more about improving the quality of your life? (Select all that apply.)

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* 7. Would you welcome personal conversations and/or coaching at your place of work about improving the quality of your life? (Select which statement applies best to you.)

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* 8. What problems, emotions, or frustrations do you think about on a daily basis in or outside of work? (ex/ I feel stuck, I feel out of shape, I’m exhausted all the time, I generally feel unhappy, I wish I had a better life partner, etc.)

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* 9. Conversely, what are your hopes or dreams to achieve for yourself now or in the future (big or small)? (ex/ I want to travel, I want to be financially independent, I want to improve my quality of life, etc.)

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* 10. What has been the greatest experience or advice you’ve been given to date that you feel had positive impact on the quality of your life in or outside of work? (Ex/ a specific event, experience, person, information source, or activity)

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