Free Wellness Proposals - Free Wellness Quotes

Use This Form to Request Your Free Wellness Proposals - Free Wellness Quotes

Please complete the following no risk, no obligation request for wellness proposals. The form generally takes less than 3 minutes to complete. By submitting information to us you confirm that you are an authorized representative for the company and acknowledge that this free proposal service is designed to assist you in your search for wellness programming, services and / or products.

 First Name

 Last Name

 Street Address

Address Line 2 

 City

 State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC

 Zip Code

 Phone Number

 Email Address

 Company Name:

Company Website (for verification purposes) 

 Your relationship to the company? Employee Intern / Student Insurance Broker Other Third-Party Representative

 Number of Employees:

 Number of Employee Locations:

 Your Goals for a Wellness Program: (Check all that apply)

Reduce Insurance Costs

Attract / Retain Employees

Reduce Absenteeism

Increase Productivity

Premium Differential (Those who participate versus those who don't)

Premium Differential (Based on health status)

Have a proactive (versus reactive) benefit plan design

 Interests: (Check all that apply)

Onsite Health Screenings

Employee Training / Education Programs

Health Risk Assessment

Health Coaching / Health Management

Behavior Modification (smoking cessation, stress management, weight loss, etc.)

Employee Assistance Programs

Disease Management Programs

Incentive Programs

Fitness Center Management

Gym Discounts

Health Fairs / Wellness Fairs

Full-time / Part-time Onsite Health Promotion Expert

Health Challenges

Internet tools and other online wellness programs

Flu Shots

Executive Wellness Programs

Onsite Spa Services

Onsite Medical Staffing

Points based tracking of participation

 When do you plan on implementing a Wellness Program?

1-3 Months

3-6 Months

6-12 months

No firm date set

 What is you benefit renewal date?

Budget Per Employee Per Month (PEPM) for wellness programs?

 

No employer investment

$0.01 - $0.99 PEPM

$1.00 - $1.99 PEPM

$2.00 - $2.99 PEPM

$3.00 - $3.99 PEPM

$4.00 - $4.99 PEPM

$5.00 - $5.99 PEPM

$6.00 - $7.99 PEPM

$8.00 - $10.00 PEPM

$10.00 + PEPM

 Are you responsible for deciding how and when to pursue a Wellness Program?

Yes, solely

Yes, as part of a group

No, who is?

Please attach any documents needed here: 

 By submitting information to Infinite Wellness Solutions you confirm that you are an authorized representative for the above listed group and acknowledge that this free proposal service is designed to assist you in your search for wellness programming, services and / or products.

I agree

 Indicates Response Required