
Company Name:
Company Address:
City/Suburb
State/Province
Postal/Zip Code
Contact Person:
Contact Person Title:
Phone Number:
Email Address:
Company Industry:
Number of Employees:
Primary Company Goals for Wellness Program:
Current Wellness Initiatives, if any:
Preferred Seminar Format:
In-person
Virtual (Live Webinar)
Hybrid (In-Person & Virtual)
Please specify any platform requirements for virtual seminars:
Preferred Seminar Dates/Times: (Please provide a range of dates and times that work best):
1 st choice
2nd choice
3rd choice
4th choice
Seminar Duration:
30 minutes
45 minutes
1 hour
Other (Please specify):
Preferred Seminar Frequency:
One-time event
Monthly
Quarterly
Other (Please specify):
Target Audience for Seminars:
All employees
Specific departments
Leadership team
Other (Please specify):
Estimated Number of Participants per Seminar:
Preferred Language(s) for Seminars:
Any Accessibility Requirements for Participants:
Hearing impairments
Visual impairments
Physical disabilities
Other (Please specify):
Budget for Wellness Seminars:
Do you have a space to hold the seminars onsite?
If yes, please describe the space:
Please indicate your level of interest in the following seminar topics:
(Use a rating scale: 1 = Not Interested, 2 = Slightly Interested, 3 = Moderately Interested, 4 = Very Interested, 5 = Extremely Interested)
Seminar Topic | Rating (1 = Not Interested, 5 = Extremely Interested) | ||
|---|---|---|---|
A | B | ||
1 | Mental & Emotional Wellbeing: | ||
2 | Stress Management | ||
3 | Building Resilience | ||
4 | Mindfulness & Meditation | ||
5 | Work-Life Balance | ||
6 | Emotional Intelligence | ||
7 | Managing Anxiety & Depression | ||
8 | Burnout Prevention | ||
9 | Improving Sleep Hygiene | ||
10 | Physical Health & Nutrition: | ||
11 | Healthy Eating Habits | ||
12 | Nutrition for Energy & Productivity | ||
13 | Weight Management | ||
14 | Introduction to Fitness | ||
15 | Ergonomics & Workplace Posture | ||
16 | Preventing Workplace Injuries | ||
17 | Importance of Hydration | ||
18 | Cooking Demonstrations for healthy meals | ||
19 | Productivity & Performance: | ||
20 | Time Management & Productivity | ||
21 | Effective Communication Skills | ||
22 | Team Building & Collaboration | ||
23 | Goal Setting & Achievement | ||
24 | Leadership Development | ||
25 | Managing Distractions | ||
26 | Financial Wellness: | ||
27 | Budgeting and Financial Planning | ||
28 | Retirement Planning Basics | ||
29 | Managing Debt |
Please list any other wellness topics your company is interested in:
What are the biggest wellness challenges your employees currently face?
Are there any specific concerns or issues you would like the wellness seminars to address?
What metrics will you use to measure the success of the wellness seminars?
How will you promote the wellness seminars to your employees?
Do you have any existing employee feedback or survey data regarding wellness needs?
Is there anything else you would like to add or discuss?
Thank you for completing this form. We will review your information and contact you to discuss your company's wellness needs.
Form Template Insight
Please remove this form template insight section before publishing.
Important Considerations:
Let's break down this Corporate Wellness Seminars Client Intake Form section by section, providing detailed insights into its purpose and importance:
I. Company Information:
Purpose: This section establishes a foundational understanding of the client company. It gathers essential contact information, industry details, and the company's overall wellness objectives.
Importance:
Key Considerations:
II. Seminar Logistics and Preferences:
Purpose: This section focuses on the practical aspects of seminar delivery, ensuring a smooth and effective experience.
Importance:
Key Considerations:
III. Seminar Topic Preferences:
Purpose: This section is the heart of the intake form, allowing the client to express their specific interests and needs.
Importance:
Key Considerations:
Topic Grouping: the grouping of topics makes it easier for the client to select the catagory that they are most interested in.
IV. Additional Questions:
Purpose: This section delves deeper into the company's specific challenges, concerns, and expectations.
Importance:
Key Considerations:
V. Follow-Up:
Purpose: This section establishes clear communication channels and ensures a smooth transition to the next phase of the process.
Importance:
Key Considerations:
Overall Insights:
To configure an element, select it on the form.