Wellness Checkpoint

We are excited to see you for your upcoming wellness check. Our goal is to be the best wellness and fitness partner for you. Please complete this short survey so we are better prepared for your appointment. Thank you! CHFC Fitness Team

Full Name

Email Address

PhonePreferred Number

What would you like the focus of your wellness checkpoint to be? *

Review goalsDiscuss barriers/challengesExperienced a big life changeNeed help with accountablityMeasurementsNeed some motivationRequesting a new exercise

Do you have any medical/medicine changes? *NoYes

Medical changes

Do you have any new concerns? *NoYes

Concerns

Would you like a new program? *NoYes

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