F/S Fitness Assessments for BCBS Wellness Program

Faculty/Staff Bluehealth Rewards Fitness Assessment Request Form
Name:*

First NameLast Name
E-mail:*
Phone Number:*

Area CodePhone Number
When did you last have a fitness assessment done by FitRec?
How satisfied are you with the current amount of physical activity you do per week?

Very SatisfiedSatisfiedSomewhat DissatisfiedCompletely Dissatisfied
Should be Empty:

Faculty/Staff Bluehealth Rewards Fitness Assessment Request Form