New Participant Orientation

Hello & Welcome to Healthy Lifestyles!

Please take some time to fill out your information and watch our introduction video.

You will receive a Welcome email from WellSteps in 7-10 business days after completing this activity. (Please note that between Oct. 31st and Dec. 31st WellSteps accounts are not accessible.)

Welcome to our program!

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* 1. Full Name:

First Name

Last Name

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* 2. EIN (6 digit employee ID number, if adult designee, EIN followed by a 1, i.e. if employee's EIN was 123456, then adult designee's EIN would be 1234561.)

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* 3. Contact Information

Email Address

Phone Number

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* 4. What is your date of birth?

Input or select date

Date

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* 5. How do you identify?

Female

Male

Non-binary

Prefer not to say

Prefer to self-describe

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* 6. What is your preferred language?

English

Chinese

French

Spanish

Tagalog

Vietnamese

Other (please specify)

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* 7. Please select:

FT/PT employee eligible for benefits

Spouse/Adult designee of county employee (An adult designee can be anyone living in the household over the age of 18)

PT employee not eligible for benefits

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* 8. Please select:

First time joining Healthy Lifestyles.

Past participant wishing to restart the Healthy Lifestyles program.

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* 9.
Watch this Introduction to Healthy Lifestyles video.

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* 10. How did you hear about the Healthy Lifestyles program? (Check all that apply)

Co-worker

E-Connect

Family member

Healthy Lifestyles Website

Healthy Lifestyles Workshop

New Employee Orientation

Benefits Fair or Benefits Brochure

Other (please specify)

New Participant Orientation

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* 1. Full Name:

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* 2. EIN (6 digit employee ID number, if adult designee, EIN followed by a 1, i.e. if employee's EIN was 123456, then adult designee's EIN would be 1234561.)

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* 3. Contact Information

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* 4. What is your date of birth?

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* 5. How do you identify?

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* 6. What is your preferred language?

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* 7. Please select:

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* 8. Please select:

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* 9. Watch this Introduction to Healthy Lifestyles video.

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* 10. How did you hear about the Healthy Lifestyles program? (Check all that apply)

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* 11. What questions do you have for Healthy Lifestyles?

* 9.
Watch this Introduction to Healthy Lifestyles video.