Jump Start Registration
Jump Start is an 8-week, virtual program designed for those who haven't yet made exercise a habit. The tools you'll receive will help you develop a personalized exercise program. All classes are 30 minutes and meet Wednesdays at 10am CT/11am ET from Feb 11 - April 8. Our pre-assessment questions will be asked again at the end of the program to determine progress that was made.
Name
*
First Name
Last Name
Email
*
example@example.com
Are you covered by a Dow health insurance plan? Please note that if you are not covered by a Dow health insurance plan you are not eligible to participate in this program.
*
Yes
No
Are you an employee, spouse, or dependent?
*
I am a Dow employee
I am a spouse of a Dow employee
I am a dependent of a Dow employee
What is the employee work location?
*
Collegeville
Houston
Lake Jackson
Midland
Other
How did you hear about this program? Choose all that apply.
*
Notes from the Coach email
Email from Dow
Newsletter
Poster/flyer
Co-worker or family member
Referral from QuadMed staff
Personify Health platform
Other
On average, how many minutes are you active in a week?
*
Number of minutes per week
How often are you standing up/moving during a typical work day?
*
Not at all
1-2 times a day
3-4 times a day
5 or more times a day
On a scale of 1 to 10, with 1 being the lowest energy and 10 being the highest energy, how would you rate your energy level on an average day?
*
Lowest energy
1
2
3
4
5
6
7
8
9
Highest energy
10
1 is Lowest energy, 10 is Highest energy
Please indicate how much you agree with the following statements.
*
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I make the time to be active
There are a variety of physical activities that I enjoy doing
I'm confident that I know how to exercise
I can overcome challenges that prevent me from being more active
I make goals for my physical health
I can articulate my own wellness vision
I can identify challenges that prevent me from being more active
I have habits that contribute to a healthy lifestyle
I feel accountable toward achieving my goals
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