Interested in Health & Wellness Coaching or a Health Screening

Interested in Health & Wellness Coaching or a Health Screening

To help us best match your interest in coaching to one of our certified coaches, please answer the following questions.

Note: Health coaching is not mental health counseling or behavioral health support. If you are seeking mental or behavioral health support, please contact DH EAP, KGA, DHBHS, or Cobalt. If this is an emergency please call/text 988, call 911 or visit the Emergency Room.

What is your full name? (First MI. Last)*

What work group are you associated with?*

If you are the spouse of an employee, please select other.

Select

What department(s) do you work in?*

How did you hear about health coaching at DH?*

An announcement

At a health screening

Friend/Colleague

Intranet site

Internet site

ManageWell

My provider

My supervisor/manager

The Pulse

Other

What is your preferred email address?*

What is the preferred phone number to reach you?*

Phone

What is the best way to contact you?*

work phone

work email

personal email

personal phone

What are your interests in coaching?*

Exercise

Health Screening (in-person @ DHMC)

Lifestyle

Nutrition

Sleep

Stress

Tobacco/Vape

Weight Management

How would you prefer to engage with a coach?*

In-person at DHMC (limited availability)

Telephone

Virtual/WebEx

What days of the week work best for you?

Monday

Tuesday

Wednesday

Thursday

Friday

What is the best time of day? In general, coaching sessions take 30-60 minutes.*

8:30 a-9a

9a-10a

10a-11a

11a-12p

12p-1p

1p-2p

2p-3p

3p-3:30p

Is there any other information you would like to share (other than personal health information)?

Send me a copy of my responses

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