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2012
July
U
UDC Workplace Wellness Survey
UDC Workplace Wellness Survey
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Section 2 Current Level of Wellness
Are you overweight (defined as having body mass index (BMI) of 25-30) or obese (BMI over 30)? (BMI formula: your weight in pounds รท your height in inches x 703)
Yes
No
Are any of your dependants overweight or obese?
Yes
No
Do you smoke?
Yes
No
Do any of your dependents smoke?
Yes
No
Are you or any of your dependents currently being treated for any of the following? (please check all that apply)
High Blood Pressure
High Cholesterol
Diabetes
Depression or other mental health issues
Stress Management
Other (please list)
Has your medical professional recommended that you or any of your dependents? (please check all that apply)
Lose weight
Stop smoking
Get more exercise
Lower your cholesterol
Lower your blood pressure
Seek counseling for mental or emotional health
Other (please list)
Section 3: Wellness Interests
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