Workplace Wellness Initiative

At Four Peak Fitness, we believe that your health and well-being are key to both personal and professional success.

This 5 minute questionnaire is designed to help us understand your wellness goals, challenges, and how we can tailor a programe specific to you.

Your responses will give us the information we need to help you feel your best both in and out of work.

Thank you for taking the time to complete this questionnaire.

If you're unsure of an answer or prefer to not answer just leave it blank.

We look forward to supporting you on your journey to better health!

First name

Last name

Date of Birth

Employer

Personal Well-Being Reflection

1. How would you rate your overall physical health right now?

On a scale of 1 Extremely Poor to 10 Extremely Good

Why did you give yourself this rating?

2. How would you rate your current energy levels throughout the day?

On a scale of 1 Extremely High to 10 Extremely Low

What factors contribute to your energy levels?

3. How often do you experience stress or anxiety during your workday?

Scale: 1 = Never, 10 = Very Often

In reflection, what are some causes for stress in your life?

4. How often do you feel fatigued or have difficulty concentrating?

Scale: 1 = Rarely, 10 = Frequently

How does this impact your daily productivity and personal life?

5. Do you feel your current physical health or mental well-being affects your performance at work?

Yes/No

If yes how

Health and Wellness Goals

6. What are the top three personal health or wellness goals you would like to achieve?

e.g., better sleep, more energy, weight loss, reduce stress, improve physical fitness, etc.

Why are these goals important to you?

If you could improve just one area of your health right now, which would it be and why?

7. How motivated are you to make changes in your health habits?

1 = Not Motivated, 10 = Extremely Motivated

What might make you feel more motivated to take action?

8. What challenges do you face when trying to maintain a healthy lifestyle?

e.g., time constraints, lack of knowledge, stress, motivation, environment, etc.

9. How interested would you be in participating in a wellness program that supports physical health, stress management, better recovery, more energy, and overall well-being?

1 = Not Interested, 10 = Extremely Interested

Why did you give yourself this rating?

10. Would having access to personalized support (e.g., fitness routines, nutrition guidance, stress management techniques) help you feel more equipped to meet your health goals?

yes/no

What factors contribute to your energy levels?

11. Would you be open to company support in achieving your personal health goals?

Yes/No

12. What motivates you to make lasting changes in your lifestyle and health habits?

e.g., family, work performance, personal growth, improved mood, better quality of life, etc.

13. How ready are you to take the next step towards improving your health and well-being?

Scale: 1 = Not Ready, 10 = Extremely Ready

What would help you feel more confident in taking this step?

14. Is there anything else you would like to share about your health journey or thoughts on how a wellness program could help you?

Thanks for submitting!

Thank you for taking the time to complete this questionnaire. Your responses are incredibly valuable in helping us understand your unique health and wellness needs. By sharing your thoughts, you’ve taken an important step toward improving your well-being, and we are excited to support you on this journey.