Share Your LiveWELL Success Story

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1. What is your first and last name? (Required.)

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2. I am a: (Required.)

Colleague

Spouse/LDA

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3. I am a colleague/spouse/LDA of: (Required.)

St. Elizabeth’s Hospital – O’Fallon

St. Joseph’s Hospital – Breese

St. Mary’s Hospital – Decatur

St. Anthony’s Memorial Hospital – Effingham

St. Joseph’s Hospital – Highland

St. Francis Hospital – Litchfield

St. John’s Hospital – Springfield

Holy Family Hospital– Greenville

St. Joseph’s Hospital – Chippewa Falls

Sacred Heart Hospital – Eau Claire

St. Mary’s Hospital Medical Center – Green Bay

St. Vincent Hospital – Green Bay

St. Clare Memorial Hospital – Oconto Falls

St. Nicholas Hospital – Sheboygan

HSHS Medical Group, Inc.

Prairie Cardiovascular Consultants, Ltd.

Prairie Education and Research Cooperative

Hospital Sisters Health System

Good Shepherd Hospital - Shelbyville

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4. Current LiveWELL Level? (Required.)

Level 1 (1,000 to 2,499 points)

Level 2 (2,500 to 4,999 points)

Level 3 (5,000 points and above)

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5. What is your favorite LiveWELL challenge category so far? (select one) (Required.)

Physical

Financial

Emotional

Work Well-being

Why?

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6. Tell us what you have liked most about HSHS LiveWELL and/or share your success story. (Required.)

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7. HSHS will highlight colleague stories on the HSHS Benefit website (Share Your Story examples) and/or in other publications. Are you interested in sharing your story publicly? (Required.)

Yes, I am willing to share my story!

No, I do not want my story to be shared publicly.

Share Your LiveWELL Success Story

Question Title

1. What is your first and last name? (Required.)

Question Title

2. I am a: (Required.)

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3. I am a colleague/spouse/LDA of: (Required.)

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4. Current LiveWELL Level? (Required.)

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5. What is your favorite LiveWELL challenge category so far? (select one) (Required.)

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6. Tell us what you have liked most about HSHS LiveWELL and/or share your success story. (Required.)

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7. HSHS will highlight colleague stories on the HSHS Benefit website (Share Your Story examples) and/or in other publications. Are you interested in sharing your story publicly? (Required.)

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8. If you answered ‘yes’ to Question 7, please upload a photo of you “living well” to be used if your story is selected.

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9. What type of LiveWELL challenges would you like to see in the future? (Required.)

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* 1. What is your first and last name? (Required.)

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* 2. I am a: (Required.)

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* 3. I am a colleague/spouse/LDA of: (Required.)

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* 4. Current LiveWELL Level? (Required.)

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* 5. What is your favorite LiveWELL challenge category so far? (select one) (Required.)

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* 6. Tell us what you have liked most about HSHS LiveWELL and/or share your success story. (Required.)

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* 7. HSHS will highlight colleague stories on the HSHS Benefit website (Share Your Story examples) and/or in other publications. Are you interested in sharing your story publicly? (Required.)

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* 8. If you answered ‘yes’ to Question 7, please upload a photo of you “living well” to be used if your story is selected.

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* 9. What type of LiveWELL challenges would you like to see in the future? (Required.)

1. What is your first and last name? (Required.)

2. I am a: (Required.)

3. I am a colleague/spouse/LDA of: (Required.)

4. Current LiveWELL Level? (Required.)

5. What is your favorite LiveWELL challenge category so far? (select one) (Required.)

6. Tell us what you have liked most about HSHS LiveWELL and/or share your success story. (Required.)

7. HSHS will highlight colleague stories on the HSHS Benefit website (Share Your Story examples) and/or in other publications. Are you interested in sharing your story publicly? (Required.)

8. If you answered ‘yes’ to Question 7, please upload a photo of you “living well” to be used if your story is selected.

9. What type of LiveWELL challenges would you like to see in the future? (Required.)