Trillium Wellness Survey Question Title * 1. What makes you want to improve your health? More energy Feel better Look good Rewards Other (please specify) Question Title * 2. Did you get a flu shot this season? Yes No Question Title * 3. What do you consider your most important health issue right now? Tobacco use overweight or obese Pain management Diabetes control or prevention Heart health Other (please specify) Question Title * 4. Do you exercise? Not at all Sometimes Regularly Question Title * 5. What do you do for exercise? Walking Running Fitness club Exercise class Bike Other (please specify) Question Title * 6. Do you use tobacco? Yes No Question Title * 7. If you use tobacco, are you considering quitting in the next year? Yes No Not applicable, I do not smoke Question Title * 8. Have you tried to quit tobacco before? Yes No Not applicable, I do not smoke Question Title * 9. If you have tried to quit using tobacco before, how many times have you tried to quit? Question Title * 10. Have you tried to lose weight in the last year? Yes No Question Title * 11. How did you try to lose weight? Diet Exercise program Medication Surgery Other Not applicable, I did not use a weight loss method Question Title * 12. Have you joined a program or support group for weight loss? Yes No Question Title * 13. If yes,what programs or groups? Weight Watchers Overeaters Anonymous Other Other (please specify) Question Title * 14. Do you get an annual physical? Yes No Question Title * 15. Do you have preventive screenings when reccomended by your Doctor? Yes No Question Title * 16. What type of screenings have you had? Pelvic exam Prostate Colonoscopy Mammogram Other (please specify) Done