PreCall Survey

1
Hey! Let's start simple, which best describes your energy level?* This field is required.11 Quick questions to help us know if our highly selective program is compatible with your needs
Feeling Old
Neutral
Dialed In
2
Do any of the following statements apply to you?* This field is required.Check all that apply. If none of these statements apply to you please type in a statement that does apply in "Other"
I have less muscle mass and more belly fat than I would like
My mental clarity is not optimal
I have low energy and/or motivation levels
My libido is not what it once was
🛑 Any form of cancer (excluding skin), or heart issues (clots, thrombosis, stents, stroke or failure)?
🛑 Reside in (AK, HI, ID, MT, ND, PR, SD, WY) OR or under the age of 28?
Other
3
What's your name?* This field is required.
Enter your name here
4
Great! {Name}, what's the best email to reach you at?* This field is required.
Enter your email here
5
{Name}, tell me about your current profession* This field is required.What you do and how you spend your days are integral to how we refine your program
Entrepreneur/ Founder/ Business owner
Executive
Professional (dentist, M.D., lawyer, finance, etc.)
Employee
6
What significant commitments have you made in yourself in the past?* This field is required.Check All That Apply:
Gym Membership / Workout Plans (P90x...etc.)
Masterminds / Business Coaching
1:1 Personal Trainer/ Online Coach/ Nutritionist
Hormones/HGH/Peptides/Functional Medicine/etc.
Peloton/ Tonal/ Technogym
I never invested in any program or service in this category
Other
7
What is your ultimate goal?* This field is required.Please be specific and explain why you need Dr. Ryan’s help. Goals do not need to be physical goals.
8
What has been your greatest obstacle to achieving your goals and/or sustaining them? Please provide as much detail as you can* This field is required.Keep it simple. Please write the first things that come to mind
9
Dr. Ryan's Longevity Medicine Program is a highly selective service for high-achieving, ambitious executives, business owners and entrepreneurs. If this premium program aligns with your needs and resources, how soon would you be able to start?* This field is required.
Today
Now is DEFINITELY NOT the right timing, just looking for information
Within the next month
Within the next week
Undecided / Not Ready Yet
10
High-end, customizable services such as the Longevity Medicine Program from Dr. Ryan are extremely rare. They’re designed for high net-worth individuals with busy lives who are prepared to invest their time, focus, and a minimum of $15,000 (USD) towards making fitness and health a priority. (Note: satisfaction is guaranteed.)* This field is required.
NO - I do not have the resources to invest into my future right now (I have $0 available for investing in myself)
YES - I have the time and resources right now
11
ONE LAST STEP! Enter your phone number & Click SUBMIT so that we can assess your needs. If you’re compatible, we’ll direct you to our online calendar to schedule a Zoom Video Conference at your convenience. In that meeting, we’ll answer any questions, explore your needs further, and offer a more complete description of the program* This field is required.(Just in case we can't connect on zoom)
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