GoPivot Needs Assessment

Organization Overview

Rewards for Wellness^TM Engagement Program successfully encourages and promotes wellness compliance among corporate employees and health plan members. To help us design a program customized for your company, please review the metrics below and then rate the urgency of your need to improve compliance in each area.

Question Title

* First we need some information about your organization.

Company name

Address

City

State

Zip Code

Contact Name

Contact Title

Contact Phone

Email Address

Website

Target start date

# of employee

# of male employees

# of male employees over age 40

# of female employees

# of female employees over age 40

# of employees over age 50