Wellness Check-In Please take a moment to fill out the form below! Executive Wellness Check In "*" indicates required fields Name* First Last Email* Phone*Are you physically active at least four times a week?* Yes No Do you consume enough at least 5 servings of fruits and vegetables daily?* Yes No Do you eat protein every 3–4 hours?* Yes No Do you have strategies in place to manage my stress levels on a day-to-day basis?* Yes No Do you engage in any unhealthy habits or behaviors, such as smoking or excessive drinking?* Yes No Do you have a support system in place for my physical and mental health, such as friends, family members, or healthcare professionals?* Yes No Do you regularly see a healthcare provider for check-ups, preventative care, and other medical needs?* Yes No Are you willing to make sustainable changes to lifestyle and habits to prioritize your own health and wellness?* Yes No