Try Out Lifelong Wellness Academy - Survey

Your Email Address

What is your gender?

Male
Female

What is your age group?

I am in my 20's
I am in my 30's
I am in my 40's
I am in my 50's
I am in my 60’s
I am in my 70’s or older

Are you a fitness trainer, physical therapist, or other health professional?

Yes
No

Which health & fitness goal is MOST IMPORTANT to you right now?

Lose Weight / Get In Shape
Get Stronger / Build Muscle
Overcome Current Injuries
Longevity / Safe Training / Increase Energy

Neck Pain

Shoulder Pain

Elbow Pain

Wrist & Hand Pain

Back Pain

Hip Pain

Knee Pain

Foot & Ankle Pain

Do you have/are you concerned about Diabetes? (CHECK IF APPLIES)

Do you have/are you concerned about Alzheimer’s? (CHECK IF APPLIES)

Do you have/are you concerned about Heart Disease? (CHECK IF APPLIES)

Do you have/are you concerned about Muscle Pain? (CHECK IF APPLIES)

Do you have/are you concerned about Vision Health? (CHECK IF APPLIES)

Do you have/are you concerned about Joint Pain? (CHECK IF APPLIES)

Where do you live?

USA
Canada
Europe
Mexico
Central or South America
Australia or Surrounding Area
Asia or Africa

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