HII: Weigh Beyond Plus Registration and Pre-Program Assessment (2025)

Weigh Beyond Registration & Pre-Program Assessment

Hello and welcome to Weigh Beyond!* The program occurs Wednesdays from July 2 through September 3 at 4 p.m.
Please take a few minutes of your time to answer the questions below. These questions will be asked at the beginning and the end of the program and will help us better understand the behavior change that occurs during the program.
Name*

First NameLast Name
Work Type*
Work Location*
Age Range

18 - 3031 - 4041 - 5051 - 6061+
Date of Birth*

MonthDayYear
What is your gender identity?*

FemaleMaleOtherTransgender FemaleTransgender MaleChoose Not to Disclose
How tall are you?*
How much do you weigh?*
Which statement best describes your physical activity level in the past two months?*

I don’t walk/exercise regularly and don't plan to startI don't walk/exercise regularly but I've been thinking about startingI'm active but do not have any planned exercise timeI exercise a few days a week but could be doing moreI get the recommended 150 minutes of exercise each week
Which statement best describes your diet of whole grains, fruits, veggies and lean protein in the past two months?*

I do not eat a diet with any of those foods and am not planning to startI have been thinking about starting to eat a diet containing these foodsMy diet has these foods but not at every mealThe majority of my meals have all these food groupsEvery meal I eat has the recommended servings of whole grains, fruits, veggies and lean protein
In the past 2 months, on average how many times did you have fast food each week?*

01-23-56+
On average, how many hours of sleep do you get each night?*
Please rate your average stress level.*

1

2

3

4

5

1 is Never Stressed, 5 is Always Stressed

How often do you do the following?*

	Never	Sometimes	Frequently	Always
Meal planning
Exercise planning
Healthy goal setting
Track your activity
Track your food
Drink soft drinks or other sweetened beverages
Consider if what you're eating is healthy
Consider if you're eating because you're hungry or for another reason

How did you hear about this program? Select all that apply.

BeWell Bulletin monthly newsletterDepartment meetingsDigital monitorsEmailmy.Hii.com/HIIbenefits.comMy leadermyquadmed.com/bewellMobile app (Ingalls Connect, HII TechKnow, NNS to Go)Nutrition Bytes monthly newsletterPostal mailPosterQuadMed provider/coachWellness OnlineWord of mouth
*If you are interested in receiving medication to aid in weight loss, this program can help fulfill the requirements needed for approval and prescription from your HII Family Health Center provider as a part of the clinical weight management program.

BeWell for Life wellness services are available to all HII employees, regardless of medical coverage. Some services may be limited to the HII Family Health Center or online.
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Weigh Beyond Registration & Pre-Program Assessment