Wellness Retreat WebInar Survey

A few demographics to begin with!

Help us find a Wellness WebInar for You!

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* 1. What is your age range?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 2. What gender do you associate with?

Female

Male

Do not wish to declare

Gender Identity (if you wish to declare)

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* 3. What race or ethnicity are you?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Declare race or ethnicity to be added to database

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* 4. Which of the following categories best describes your employment status?

Employed, working full-time

Employed, working part-time

Works at home

Not employed

Retired

Student

Disabled

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* 5. Do you ever feel?

Sad

Tense or anxious

Fatigued

Lack of Interest

Lack of Motivation

Depressed

Overwhelmed

Stressed

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* 6. Are you concerned about the stress in your life?

Yes

Sometimes

Not Sure

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* 7. Would you say stress impairs/ impacts your work relationships?

Yes

Sometimes

Not Sure

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* 8. Do you feel that stress impairs / impacts your personal relationships?

Yes

Sometimes

Not Sure

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* 9. Are you struggling with a medical condition (s) as well?

Yes

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* 10. Has taking care of others gotten in the way of taking care of yourself?

Yes

Not Sure

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* 11. Do you agree that (pick one)

You are satisfied with your nutrition

You would like some new cooking ideas

You wish you knew more about healthy diets

Your diet is not as healthy as it could be

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* 12. Meditation ...... (choose the best answer for you)

My meditation practice works for me

I want to improve my meditation practice

I would like to learn about meditation

Meditation is not for me

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* 13. Who can you count on for emotional support? ( check all that apply)

Partner

Close family member

Friend (s)

Co-worker (s)

Health Care Provider

I have no supports

Other (please specify)

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* 14. Would you say any of the following are true for you? (Check all that apply)

I wish I knew more about stress management

I would like a stress management program that suited my lifestyle

I wish I knew more about healthy lifestyles

I am considering lifestyle changes but do not know where to begin

I know the lifestyle changes I need to implement

I have difficulty with motivation

I have difficulty with change

I have difficulty following through with new plans

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* 15. Would you say you are struggling with fatigue ?

Yes

If so, in what way?

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* 16. Are you concerned about Coronavirus infection or recovery challenges if you have already had the virus?

Yes

If, you have a specific concern regarding the pandemic you would like to see addressed in a WebInar, please let us know