Form Center

2. Reimbursement has been limited in the past to employees and their spouses only, are there others you would like included in our program?
4. Would you terminate your gym membership if premium reimbursements are not offered next year?*

   1. yes
   2. no
6. The city is looking into an alternative incentive for the fitness center reimbursement program. Which of the following incentives appeal to you?*

   1. Earning points in IPROPEL to purchase items of my choice
   2. Receiving a city issued credit toward my fitness center premiums each month (regardless of the gym and the number of days I attend).
   3. Expanding the number of contracted gyms with reduced rates for city employees
   4. Utilizing a city owned fitness center at no charge
   5. Receiving a discount toward my medical insurance premiums
   6. Other
8. Alternative Incentive - Other
10. Of the following, which would you prefer be included in our Reimbursement Program (for you or a member of your household)?*

    1. Gym, fitness center/studio, health club, swim & tennis club memberships and fees
    2. Fitness and nutrition counseling
    3. Fitness and sports classes/lessons
    4. Personal trainer sessions
    5. Martial arts instruction
    6. Sports league or team fees
    7. Weight loss and smoking cessation programs, including memberships
    8. Yoga, Pilates, and meditation classes
    9. Health Assessments and Preventive Screenings
12. In March we reimbursed employees for making the required number of monthly visits to the gym during 2019. Did you receive any reimbursement for visits you made or your spouse made?*

    1. yes
    2. no
14. Fitness Centers have begun Phase 2 of the re-opening after Covid-19 closures. When do you plan to return to the fitness center?*

    1. Immediately – As soon as they open
    2. Soon – Within the next 3-6 months
    3. I’m not sure – I need more time to decide.
    4. I plan to cancel my membership
16. What are your thoughts about paying the fitness center directly each month verses having a payroll deduction?
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field