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Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
For Employees
Step
1
of
4
25%
Name of Company
Company Contact Name
Date
MM slash DD slash YYYY
Are you interested in attending Pilates, yoga, or meditation classes offered at work?
Yes
No
Maybe
Mark the boxes of the classes you are interested in attending.
Yoga
Pilates
Meditation
Would you be interested in classes other than Pilates, yoga, or meditation? Please specify.
What times do you prefer to attend a workplace fitness class?
early morning (before work)
lunchtime
end of a work day
anytime
How often will you attend fitness classes offered at work?
1X
2X
3X
every day
never
Rate the amount of fatigue you feel in your neck, shoulders, and jaw on a scale of 1 - 5 after a long workday.
1
2
3
4
5
Rate the amount of fatigue you feel in your upper back on a scale of 1 - 5 after a long workday.
1
2
3
4
5
Rate the amount of fatigue you feel in your lower back and hips on a scale of 1 - 5 after a long workday.
1
2
3
4
5
Rate the amount of fatigue you feel in your wrists on a scale of 1 - 5 after a long workday.
1
2
3
4
5
Rate the amount of fatigue you feel in your overall exhaustion on a scale of 1 - 5 after a long workday.
1
2
3
4
5
Rate the amount of fatigue you feel in your knees on a scale of 1 - 5 after a long workday.
1
2
3
4
5
Rate the amount of fatigue you feel in your feet on a scale of 1 - 5 after a long workday.
1
2
3
4
5
Rate the amount of stress and anxiety on a scale of 1 - 5 after a long workday.
1
2
3
4
5
Rank the importance to you off the following benefits.
Relaxation | Stress release
Very important
Somewhat important
Not that important
Weight Loss
Very important
Somewhat important
Not that important
Muscle Toning
Very important
Somewhat important
Not that important
Pain Management | Rehabilitation
Very important
Somewhat important
Not that important
Stretching | Flexibility | Balance
Very important
Somewhat important
Not that important
Cardiovascular
Very important
Somewhat important
Not that important
If you have enjoyed fitness classes before, what have you loved about them?
If you tried a fitness class once (or a few times) and never went again, why did you stop going?
Describe your yoga experience:
Beginner
Intermediate
Advanced
Never done it
Describe your Pilates experience:
I've been to a class or two
I have attended many times
I practice regularly
Never done it
How often do you exercise?
every day
3 - 5 times a week
1 - 2 times a week
a couple times a month
rarely
What type of classes would you like to see happen at your work?
a. A relaxing stretching class
b. An athletic core centered yoga class
c. A faster paced class in which students move from pose to pose with music.
d. A slower paced class that focuses on alignment
e. A class that focuses on alleviating pain
f. A Meditation class
g. A class that emphasizes muscle toning and posture
Δ
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