Health Questionnaire (For employees NOT on the health plan through Security Administrative Services)

This health questionnaire is for MCHS employees NOT insured by Security Health Plan and will take less than 2 -minutes to complete. Your valuable feedback will help the MCHS Wellness@Work Team design programs and interventions to support employees' health and wellness goals.

Your answers will be held by Security Health Plan. Security Health Plan is required by law to maintain the privacy and security of your personally identifiable information. Your answers will never be shared publicly or with your employer without your specific authorization.

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* 1. First name

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* 2. Last name

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* 3. At which MCHS center do you primarily work at?

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* 4. What is your routing location?

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* 5. Overall, how would you rate your health?

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* 6. Do you have a primary care provider?

MCHS recommends everyone visit their Primary Care Provider (PCP) for regular physical exams that include biometric testing, preventive screenings and immunizations. Regularly visiting a PCP is associated with fewer preventable emergency room visits, fewer hospital admissions, as well as greater trust in and adherence to a PCP’s treatment recommendations.

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* 7. What are your 2022 wellness goals? (Check all that apply)


Sign up to receive the MCHS monthly wellness eNewsletter with helpful information about health topics and upcoming programs.

Thank you for your time. Your input is appreciated. Please email mchswellness@marshfieldclinic.org if you have questions.

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