Jump Start Registration & Pre-assessment (2026)
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 pre-recorded. You may go through the material at your own pace, but you need to complete the program between June 1- September 4, 2026. Our pre-assessment questions will be asked again at the end of the program to determine progress that was made. You will receive 1,000 points for completing this program. To qualify, you must meet with the Wellness Coach, Crystal Cyr at least once, as well as complete at least 5 out of 8 of the weekly worksheets on Jotform.
Name
*
First Name
Last Name
Email
*
example@example.com
How did you hear about this program? Choose all that apply.
Notes from the Coach email
Poster/flyer
QuadMed staff
Co-worker
Email from HCS
Wellness Online
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
Submit
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