First Name

Last Name

Email Address (Optional)

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. How would you rate your overall satisfaction with the LifeBalance Program?

Very Satisfied
Somewhat Satisfied
Satisfied
Somewhat Dissatisfied
Dissatisfied
Not applicable

4. How satisfied are you with the variety of LifeBalance Providers in your area?

Very Satisfied
Somewhat Satisfied
Satisfied
Somewhat Dissatisfied
Dissatisfied
Not applicable

5. How satisfied are you with the variety of LifeBalance events held in your area?

Very Satisfied
Somewhat Satisfied
Satisfied
Somewhat Dissatisfied
Dissatisfied
Not applicable

6. How satisfied were you with the process of making a purchase using your LifeBalance member benefits?

Very Satisfied
Somewhat Satisfied
Satisfied
Somewhat Dissatisfied
Dissatisfied
Not applicable

7. How many times per month do you visit the LifeBalance program website?

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

8. How satisfied are you with the ease of use of the LifeBalance website ?

Very Satisfied
Somewhat Satisfied
Average
Somewhat Dissatisfied
Dissatisfied
Not applicable

9. How would you rate your overall experience using the LifeBalance Program Search for Savings?

Excellent
Very Good
Good
Fair
Poor
Not applicable

10. How would you rate your overall experience using the LifeBalance Program Events Calendar?

Excellent
Very Good
Good
Fair
Poor
Not applicable

11. How would you rate LifeBalance email Updates?

Excellent
Very Good
Good
Fair
Poor
Not applicable

12. If you have contacted LifeBalance customer service in the past year, please rate your overall experience.

Excellent
Very Good
Good
Fair
Poor
Not applicable

13. 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

14. What new recreational or cultural businesses would like to see involved in the LifeBalance Vendor Network in your area or around the states of Oregon, Washington and Alaska? Please provide the names of the business, addresses and phone numbers if possible:

15. 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.)

Thank you for your time