Wellness Survey

1

Have you or a loved one had to visit urgent care in the past 12 months? * This field is required.

YESNO

2

Do you or a loved one use prescription or over-the-counter medication? * This field is required.

YESNO

3

Do you or a loved one suffer from stress, feelings of sadness, anxiousness, lack of sleep, difficulty concentrating, or any other concerns?* This field is required.

YESNO

4

Have you or a loved one ever had to wait days or weeks to see a primary care physician for something as simple as a note, form, or prescription refill? * This field is required.

YESNO

5

Could you or a loved one benefit from discounts on dental, vision, chiropractic, and medical supplies?

YESNO

6

What other wellness benefits might you or a loved one have need of?* This field is required.

Dermatology

Weight management

Men's health care

Women's health care

Easy access to medical records

Email consultations with primary care physicians and specialists

A dedicated concierge line for assistance and discounts

Virtual urgent care and discounts for your fur babies

7

What is your greatest challenge right now when it comes to healthcare?* This field is required.

I don't have any coverage, paying out of pocket

I have coverage but my premiums are sky high

I have affordable coverage but the benefits are inadequate

My healthcare plan is complicated to use (finding in network doctors, co-pays, deductibles, etc.)

I'm paying too much for medications

I just avoid getting sick because if I do, I'm screwed!

8

Would a convenient and affordable healthcare service that offers all the mentioned benefits—and requires no medical exams, no waiting periods, no deductibles, no exclusions, and no paperwork—be helpful to you or someone you know?* This field is required.

YESNO

9

Do you have a partner and/or dependents you'd like to add at no additional cost?You can add up to 7 people—one adult friend, partner, or family member and dependents under the age of 26.

10

Our service offers unlimited virtual urgent care, 24/7 on-demand talk therapy, and the most common medications included for free. What do you feel the value is for these services, for up to 8 people at no additional cost?* This field is required.

$499/month

$399/month

$299/month

$199/month

11

Please keep in mind that THIS IS NOT INSURANCE, so there are no contracts or commitments. You don't even need a social security number to join! Would you like to find out how much this healthcare plan costs and how you and your loved ones can start using these benefits immediately?* This field is required.

Absolutely!Maybe

12

Who should we thank for sending you this survey?* This field is required.Enter the name of the person who invited you to take this survey

13

Your Name* This field is required.

First Name

Last Name

14

We will email your results!* This field is required.

example@example.com

15

Please share your phone number if you'd like a follow-up call! Optional

Area Code

Phone Number