Corporate Wellness Program Interest Form

The purpose of this form is to identify employers, who you as their employee(s) are interested in improving their physical, mental, and emotional health to gauge their interest in offering resources, support and guidance provided by Her-bal to help you as their employee(s) achieve your overall wellness goals.

Your Name

Please fill out this field.

Your Employer

Please fill out this field.

The Human Resources (Email)

Please enter a valid email address.

The Human Resources (Phone Number)

Please enter a phone number.

Are there any resources and/or support that you feel would be beneficial in helping to improve your mental and/or physical health at work?

Please fill out this field.

Does your employer have an Employee Assistance Program and/or Wellness Program?

Yes

I'm not sure

What would you like to see your Employer offer within an Employee Assistance Program and/or Wellness Program?

Please fill out this field.