Corporate Wellness Survey Step 1 of 2 50% Thank you!We appreciate you taking a few moments to complete this survey so that we may best serve your company's needs. Because every company is different, we will take the information you provide us with and create a comprehensive plan or proposal based on your desires. If you have questions, we can be reached at (858) 847-0110 ext. 104.Your Name* First Last Name of Company*Method of Contact (Check all that apply) Telephone Email Fax PhoneFaxEmail* Company Website Number of Employees*1-1011-3031-7576-100101 - 250251 - 1,0001001 - 10,00010,000 +Address of Company Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Your Position with the Company*How did you hear about DREAM Wellness?*What Services are you Interested In?Please use this portion of the form to let us know which of the following services you would like to potentially have offered to your company's employeesWellness Assessment / Digital Nerve Scan (takes 10 minutes)*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location for Wellness Assessments*On-siteAt a DREAM Wellness LocationIt DependsBody Fat Composition (takes 10 minutes)*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location Body Composition Scan*On-siteAt a DREAM Wellness LocationIt DependsExecutive Business Coaching*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location for Executive Business Coaching*On-siteAt a DREAM Wellness LocationOver the TelephoneIt DependsIndividual Coaching for Employees*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location for Coaching*On-siteAt a DREAM Wellness LocationOver the TelephoneIt DependsTeam Building / Relationship Optimization*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location for Team Building*On-siteAt a DREAM Wellness LocationIt DependsAdvanced Human Assessment and Results Review for Team Members*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedHuman Assessments for Hiring*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedNutrition and Weight Management*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location for Nutrition*On-siteAt a DREAM Wellness LocationIt DependsChiropractic Care*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location for Chiropractic*On-siteAt a DREAM Wellness LocationIt DependsChair Massage (on-site)*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedFull Body Table Massage*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location for Table Massage*On-siteAt a DREAM Wellness LocationIt DependsAcupuncture*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location for Acupuncture*On-siteAt a DREAM Wellness LocationIt DependsPersonal Training*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location for Personal Training*On-siteAt a DREAM Wellness LocationIt DependsGroup Fitness Classes (Yoga, Pilates, Barr, etc...)*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location for Group Fitness*On-siteAt a DREAM Wellness LocationIt DependsGroup Meditation Classes*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location for Group Meditation*On-siteAt a DREAM Wellness LocationIt DependsHealthy Cooking Classes*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedPreferred Location for Healthy Cooking Classes*On-siteAt a DREAM Wellness LocationIt DependsErgonomic Makeover*Very InterestedMildly InterestedMaybe, but need more informationNot InterestedWhat other services (not listed above) would you like offered to your company and where would you like them offered?Seminars (Lunch and Learns, Half-day, Full-Day, Retreats)*Very InterestedMildly InterestedMaybe, but need more informationNot Interested Workshops, Seminars & RetreatsThis is a list of workshops that DREAM Wellness currently offers. Please check any of the workshops that you think would benefit your company / employees. Please note that while we have more than 100 options, if you let us know a topic of interest that is not listed, we can undoubtedly present something that will fill your needs!Workshops Offered Through DREAM Wellness* Living the DREAM (The 5 Facets of the Wellness lifestyle) Peak Performance Stress Management Back Safety and Injury Prevention: Secrets to a Healthy Spine 21 Day Purification Program (Detox/Cleansing) Raising Healthy Children: Naturally Stay Fit While You Sit Sit Right for Your Type 5 Secrets to Dealing with or Preventing Type II Diabetes Overcoming Fibromyalgia Improve Your Golf Game and Play Safely Headaches: A Real Pain in the Neck Finding the Fountain of Youth: Slowing the Aging Process The 10 Keys to Longevity Aging Gracefully Boosting Your Immunity The Chemistry of Life Spinal Health for Parents and Children Staying Focused on Life Straighten Up America Build Wisely: Creating a Foundation for Health, Wealth and Success Eat Smart 8 Simple Ways to Improve Sleep The Art of Meditation Backpack Safety Ergonomics 101 Self Centering / Power Centering Vaccination Facts and Myths Creating a Wow Customer Experience 25 Secrets of Extreme Profitability Irresistible Attraction 25 Secrets of Having the Life You Really Want Client Typing: Recognize Your 7 Specific Client Types Empowering People Relating to Co-workers, Clients or Customers Life Planning Personal Path: 12 Benchmarks to an Extraordinary Life Creating Financial Independence Organizational Development Listening: Hear What the Client is Saying Second Choice Business Building Attracting Ideal Clients Planning Your Time Creating and Clarifying Your Mission, Vision, Purpose and Philosophy Statements Marketing for Today and the Future Building Client Relationships for a Lifetime Hiring Your Ideal Assistant or Team Member How to Tell People What You Do and Engage Them in 15 Seconds Keys to Building Self-Esteem in Your Kids Designing the Ultimate Outcome for Your Client Introduction to Personal Coaching Introduction to Business Coaching Choosing Your Target Customer and the Cycle of Care Operate Your Business and Your Life from Your Values The Needless Program: Get Your Needs Met Goal Setting: How to Set Goals and Actually Achieve Them The Cycle of Life Alchemical Incompatibility: The #1 Killer of Relationships in Business, Home and Life Understanding How You Learn & Process Information Understanding How Others Learn & Process Information in Business, Home and Life How YOU Perceive Life
