Wait list form

1
Name* This field is required.
First Name
Last Name
2
What is your age?* This field is required.
3
Email* This field is required.
4
Phone Number(optional)
Area Code
Phone Number
5
How would you rate your overall health from 1 - 10* This field is required.
Please Select
Please Select
1 (Poor)
2
3
4
5
6
7
8
9
10 (Perfect)
6
What are your biggest health struggles right now?* This field is required.
7
How many times do you exercise per week?* This field is required.
1-2
3-5
6-10
10+
I don't exercise
8
Have you tried dieting and exercise to lose weight? If so, how many times?* This field is required.
Never
1-2
3-5
6-10
Too many times to count
9
Have you tried any of the following before?
Hormone therapy (TRT/HRT)
Sleep programs/apps (e.g. CBT-I, Oura, Eight Sleep)
GLP-1 or weight loss meds (Ozempic, Wegovy, etc.)
Concierge clinics
Supplements / self-experimentation
Other
10
Have you ever used sleep aids/pills?
Melatonin
Prescription sleep meds (e.g., Ambien, Lunesta)
Over-the-counter sleep aids (e.g., diphenhydramine, Unisom)
Other
11
Do you currently use a wearable device? If yes, select which one(s)
Oura
Whoop
Apple Watch
Fitbit
Garmin
CGM
Other
12
Do you currently take any supplements? if so, which?
13
When have you last seen a primary care doctor? (PCP)* This field is required.
6 months
1 year
2 years
More than 2years
Never/I don't have a PCP
14
Family Medical History(Please check all that apply)
Cardiac: Heart disease (heart attack, stroke, arrhythmia, heart failure)
Cancer: Colon, lung, thyroid, pancreatic, breast, prostate, other (specify)
Metabolic/Hormonal: Diabetes, hypothyroidism, hyperthyroidism, PCOS, adrenal disorders
Neurologic: Dementia, Parkinson’s, other neurologic conditions
Mental health: Depression, anxiety, bipolar, schizophrenia, substance use disorders
Other
15
Which relative was affected? (parents, grandparents, siblings)
16
Which of the following outcomes are most important to you? (Select up to 3)* This field is required.
Better sleep & recovery
More energy during the day
Sustainable weight loss
Optimized hormones (testosterone, estrogen, thyroid, etc.)
Improved sexual health/libido
Longevity & prevention
Other
17
How much have you spent on your health in the last year (excluding insurance premiums)?* This field is required.
Under $100
$100 - $500
$500 - $2,000
$2,000+
18
How soon would you want to start?* This field is required.
Immediately when invited
Within 3 months
Within 6 months
6 months+
19
How did you hear about us?
Friends & Family
Instagram
Google
Review/Comparison Article
Other
20
Would you be interested in joining as a beta tester at a discounted rate in exchange for feedback?
Yes
No
21
Schedule an interviewA 15 minute interview is not required but will raise your chances of getting accepted, we're looking for committed testers.
22
Your Signature PledgeWe only want peopleBy signing, I confirm my intent to join Outlive Biology when invited. This is a promise (no payment required at this stage).
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