First Name

Last Name

Email Address

1. How are you a member of the LifeBalance Program?

Health Insurance
Company / Employer
Don't know / Other

2. How many times did you use utilize LifeBalance benefits (discounts, events etc.) in the last year?

None
1 to 6
7 to 12
13 to 18
19 or more

3. Please rate your level of overall satisfaction with the LifeBalance Program.

Very Satisfied
Somewhat Satisfied
Satisfied
Somewhat Dissatisfied
Dissatisfied
Not applicable

4. Please rate your level of satisfaction with the variety of LifeBalance Providers in your area

Very Satisfied
Somewhat Satisfied
Satisfied
Somewhat Dissatisfied
Dissatisfied
Not applicable

5. Please rate your level of satisfaction with the variety of LifeBalance events held in your area.

Very Satisfied
Somewhat Satisfied
Satisfied
Somewhat Dissatisfied
Dissatisfied
Not applicable

6. How many times in the past month did you visit the LifeBalance program website?

1 to 6
7 to 12
13 to 18
19 or more

7. Please rate your level of satisfaction with the ease of use of the LifeBalance website.

Very Satisfied
Somewhat Satisfied
Average
Somewhat Dissatisfied
Dissatisfied
Not applicable

8. If you have contacted LifeBalance customer service in the past year, please rate your level of satisfaction with the experience.

Very Satisfied
Somewhat Satisfied
Satisfied
Somewhat Dissatisfied
Dissatisfied
Not applicable

9. Comments: If you have any specific comments for the LifeBalance program, either in relation to the questions above or something else, please let us know:

10. What new recreational or cultural businesses would like to see involved in the LifeBalance Provider Network in your area? Please provide the names of the business, addresses and phone numbers if possible:

11. What types of pre-planned recreational or cultural events are of the most interest to you and or your family? (i.e. introduction classes, sporting events,  performing arts events, etc.)

12. Where do you live?

Thank you for your time.