Corporate Wellness Survey

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.

Your Name*

First Last

Name of Company*

Method of Contact (Check all that apply)

Telephone
Email
Fax

Phone

Fax

Email*

Company Website

Number of Employees*

Address of Company

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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 employees

Wellness Assessment / Digital Nerve Scan (takes 10 minutes)*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location for Wellness Assessments*

On-site
At a DREAM Wellness Location
It Depends

Body Fat Composition (takes 10 minutes)*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location Body Composition Scan*

On-site
At a DREAM Wellness Location
It Depends

Executive Business Coaching*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location for Executive Business Coaching*

On-site
At a DREAM Wellness Location
Over the Telephone
It Depends

Individual Coaching for Employees*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location for Coaching*

On-site
At a DREAM Wellness Location
Over the Telephone
It Depends

Team Building / Relationship Optimization*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location for Team Building*

On-site
At a DREAM Wellness Location
It Depends

Advanced Human Assessment and Results Review for Team Members*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Human Assessments for Hiring*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Nutrition and Weight Management*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location for Nutrition*

On-site
At a DREAM Wellness Location
It Depends

Chiropractic Care*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location for Chiropractic*

On-site
At a DREAM Wellness Location
It Depends

Chair Massage (on-site)*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Full Body Table Massage*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location for Table Massage*

On-site
At a DREAM Wellness Location
It Depends

Acupuncture*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location for Acupuncture*

On-site
At a DREAM Wellness Location
It Depends

Personal Training*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location for Personal Training*

On-site
At a DREAM Wellness Location
It Depends

Group Fitness Classes (Yoga, Pilates, Barr, etc...)*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location for Group Fitness*

On-site
At a DREAM Wellness Location
It Depends

Group Meditation Classes*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location for Group Meditation*

On-site
At a DREAM Wellness Location
It Depends

Healthy Cooking Classes*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

Preferred Location for Healthy Cooking Classes*

On-site
At a DREAM Wellness Location
It Depends

Ergonomic Makeover*

Very Interested
Mildly Interested
Maybe, but need more information
Not Interested

What 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 Interested
Mildly Interested
Maybe, but need more information
Not Interested

Step 1 of 2

Thank you!

What Services are you Interested In?

Workshops, Seminars & Retreats

YES, WE ARE OPEN!