Consulting For Employers & Organizations Questionnaire Form

Performance Powered By Wellness

We help employers and organizations move beyond burnout, build resilience, and enable teams to thrive amidst competing priorities and demands.

* Indicates Required Fields

Point of Contact Information

Main Point of Contact: Name & Title

Phone

Alternate or Stand in Point of Contact: Name & Title

Phone

Business/Organization Information

Name

Type of Organization/Business

Organization Size

Organization website

Preferred Method of Services

Which do you prefer?

Virtual In-person

If in-person, please specify the venue:

Location

City

State

Zip code

What is your preferred timeframe or event date?

Organizational Wellness & Performance Questionnaire

Section 1: Organizational Well-Being

1. How would you describe your current workplace culture in three words?

2. What do you believe are the core stressors your team faces?

3. On a scale of 1–10, how effectively does your organization prevent burnout and support resilience?

4. Does your leadership team model healthy boundaries, communication, and stress management?

Section 2: Employee Engagement & Leadership Alignment

1. How would you rate employee engagement and morale in your organization today (1–10)?

2. Do employees feel psychological safety and trust across teams?

3. How aligned are employee values with the organization’s mission and leadership behaviors?

4. What does successful well-being look like within your team or department?

Section 3: Systems, Policy & Support

1.Does your organization currently offer health and wellness programs? If yes, how effective are they?

2. What prevents your organization from investing more in wellness or holistic leadership development?

3. What kind of outcomes would define a successful partnership with Bella Medical Associates? (e.g., lower burnout rates, enhanced performance, leadership alignment, reduced turnover, reduce interview decline rates).

Business/Organization Challenges

1. What is the top challenge that your business, organization, or team is experiencing?

2.How did you determine your business, organization or team’s top challenge?

3. What steps are you taking to address this challenge, and how effective are these measures?

5. Who is the intended audience or participants (e.g., executives, employees, or teams)?

6. How many participants are expected?

7. Are there any specific topics or focus areas you would like covered? Yes, Please elaborate.

8. What are your expected outcomes from this consulting partnership?

9. How does finding a solution for your teams’ performance and wellness align with your business or organization’s mission, vision, values, productivity statement, primary goals and top priorities for the year?

10. What significant benefits or measurable impacts do you anticipate from addressing this issue within your business, organization or team?

11. Do you require follow-up support, materials, or additional consulting or coaching after the session?

Yes No

Please elaborate or provide details

12. Which option is your business or organization ready to invest?

Short-term $15,500 - $55,000 Long-term $56,000 - $200,000?

13. What additional information would you like to share to ensure you gain the best experience from this holistic consulting solution?

14. How did you hear about our services?

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