Wellness Day Survey

1

Have you attended Wellness Day before?* This field is required.

Yes

No

2

📅 Event Details
Date: October 10, 2026
Time: 7:30 AM – 11:30 AM
Location: SMART Local 71 Union Office
24 Liberty Ave., Buffalo, NY 14215

💙 Available Wellness Services

🩸 Bloodwork & Health Screenings
🫁 Lung Cancer Screening
👂 Hearing Testing
💉 Flu Shot

🤝 Meet with Health & Benefits Experts
Representatives from the following organizations will be on-site to answer questions and provide valuable information:

Nova Healthcare
John Hancock
TruHearing
WNY Federal Credit Union (WNYFCU)
Davis Vision

✨ Take charge of your health, learn about your benefits, and connect with wellness resources—all in one convenient location!

3

Do you plan on attending Wellness Day this year?* This field is required.

Yes

No

Maybe

4

If you answered No or Maybe, please tell us why.* This field is required.

5

If you answered Yes, what improvements would you like to see in addition to the current offerings?* This field is required.

6

What incentives would make you more likely to attend?* This field is required.

7

Do you have a spouse enrolled on your healthcare coverage?* This field is required.

Yes

No

8

Would you like us to reach out to your spouse directly about Wellness Day?* This field is required.

Yes

No

9

Spouse's Full Name* This field is required.

First Name

Last Name

10

Spouse's Cell Phone Number* This field is required.

Please enter a valid phone number.

11

Spouse's Email Address

example@example.com

12

What raffle prizes would you like to see for participating?* This field is required.

13

Your Name* This field is required.

First Name

Last Name