Company Name *

Name and Title *

Email Address *

Phone Number *

Primary Office / Worksite Location(s) *

Industry *

Manufacturing / Industrial

Healthcare

Logistics / Transportation

Professional Services

Retail / Hospitality

Construction

Government / Municipal

Other

Total Number of Employees *

What best describes your workforce schedule? *

Do employees work physically demanding roles? *

Yes

No

Mixed

Are safety sensitive roles common? *

Do you have unionized employees? *

Which of the workforce challenges are most relevant today?

Fatigue / low energy

Obesity / metabolic disease

Musculoskeletal injury

Burnout

High absenteeism

Presenteeism (at work but underperforming)

Turnover

Low morale

Stress / sleep issues

Diabetes risk

Hypertension risk

Medication adherence challenges

Estimated average sick days per employee per year *

Do you currently track absenteeism trends formally? *

Have productivity losses related to health been discussed at leadership level? *

What health programs are offered currently? *

Gym reimbursement

Lifestyle coaching

Chronic disease management

GLP-1 coverage

Employee Assistance Program

Occupational health services

Wearables or health tracking programs

On-site clinics

None

Other

How satisfied are you with current wellness program engagement? *

1

2

3

4

5

Biggest limitation of current programs *

What percentage of employees may benefit from weight loss or metabolic support? *

<10%

10–25%

25–50%

50%

Is fatigue / low energy impacting safety or performance? *

Yes significantly

Somewhat

No

Unsure

Is hormone health or aging workforce performance a topic of concern? *

Yes

Emerging

No

Would employees likely engage with physician-led digital health support? *

Very likely

Somewhat likely

Unlikely

Unsure

Which program features are most valuable? *

Absenteeism reduction

Productivity improvement

Weight loss programs

Muscle preservation / injury resilience

Hormone optimization

Stress / sleep support

Digital engagement prompts

Telemedicine access

In-person clinical visits

Employer analytics dashboard

ROI reporting

Preferred delivery model *

Fully digital

Hybrid digital + in-person

On-site events

Pilot cohort first

Ideal pilot size *

25 employees

50 employees

100 employees

250+ employees

Who else is involved in benefits decision-making? *

CFO

HR Director

Risk / Safety Officer

CEO / Owner

Benefits Broker

Union Leadership

Other

Current benefits renewal timeline *

Earliest realistic pilot start date *

Within 60 days

Within 3–6 months

Next plan year

Exploring only

How are new wellness initiatives typically funded? *

Per employee per month budget

Innovation / pilot budget

Insurance premium optimization

Safety or productivity initiative

Not yet defined

What level of ROI evidence would you require? *

Modeled projections

Pilot results

Peer employer case studies

Published research

Executive sponsor approval only

Would leadership support structured employee engagement messaging (SMS/email prompts)? *

Yes

No

Maybe

Would you support incentive programs tied to participation? *

Yes

Possibly

No

In one sentence — what would success look like from this program? *

What concerns would you want addressed before launching a pilot? *

Would you like to schedule a 20-minute Employer Health Strategy Call? *

Yes → Send me the scheduling link

Not yet → Send me materials first

Just researching