First Name *

Last Name *

Phone *

Email *

How many employees are on your team? *

2-5

6-10

11-20

20+

How satisfied are you with your current healthcare plan? *

Very satisfied

Somewhat satisfied

Not satisfied

I’m unsure

What’s your biggest healthcare pain point? *

High costs and premiums

Long wait times for appointments

Complicated insurance and paperwork

Limited access to doctors or specialists

Do you currently offer healthcare to your employees? *

Yes

No

I’m planning to offer it soon

How much are you currently paying for healthcare for yourself and your employees? *

Under $500 per month

$500 - $1,000 per mont

$1,000 - $1,500 per month

Over $1,500 per month

Which state is your business located in? *

What industry does your business fall under? *

What amount are you willing to pay per employee per month for healthcare? *

Under $100

$100 - $200

$200 - $300

Over $300

How important is it for you to offer personalized healthcare for your team? *

Very important

Somewhat important

Not a priority right now

Would you be open to learning more about a streamlined, personalized healthcare solution for your business? *

Yes, I’m ready to take action!

Maybe, I need more information

Not sure yet, but I’m open to exploring options

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