2017 Lifesaver Wellbeing Series Individual Pledge

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* 1. Listed below are the eight dimensions of wellbeing. If you had the opportunity to focus on just one of these dimensions, which ONE would you choose for yourself?

EMOTIONAL- Coping effectively with life and creating satisfying relationships.

ENVIRONMENTAL- Good health by occupying pleasant and stimulating environments that support wellbeing.

FINANCIAL- Satisfaction with current and future financial situations.

INTELLECTUAL- Recognizing creative abilities and finding ways to expand knowledge and skills.

CAREER- Personal satisfaction and enrichment from one's work.

PHYSICAL- Recognizing the need for physical activity, healthy foods, and sleep.

SOCIAL- Developing a sense of connection, belonging, and a well-developed support system.

SPIRITUAL- Expanding a sense of purpose and meaning in life.

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* 2. Based on your answer to the above question, what do you pledge to do in 2017 to improve your health and wellbeing?

PLEDGE EXAMPLES:
"I pledge to participate in a new hobby."
"I pledge to have lunch with a coworker I don't know."
"I pledge to be healthier by walking to work."
"I pledge to share my time, talent and/or treasure."
"I pledge to pay off a low balance credit card."

I pledge to:

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* 3. I want to be a Lifesaver, and understand that 46.7% of all deaths in the United States could have been avoided by simply getting a physical, according to the Partnership to Fight Chronic Disease. I pledge to complete my physical this year.

Due date of physical (actual or approximate)

Date

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* 4. My primary care provider is with:

Aurora

Prevea

Ministry

Bellin Health

Holy Family Memorial

I need a primary care provider.

Other (please specify)

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* 5. What is your name and how would you like to engage with us?

Name:

Email Address:

Phone Number:

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* 6. Who is one person at your organization you can partner with to support you in accomplishing your pledge? (First & Last Name)

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* 7. Organization Name:

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* 8. Comments: