Longevity + Wellness Survey Please enable JavaScript in your browser to complete this form. 1-MINUTE SURVEY - PEPTIDE AND LONGEVITY WELLNESS 1. What is your practice specialty or structure? *DermatologyPlastic SurgeryFunctional or Integrative MedicineSkincareMedSpaOther*Choose one or more options 2. Are you offering peptides or GLP's at your practice currently? *YesNoNot Sure3. Which peptides are you offering at your practice currently? (if any) *Example: GLP-1 such as Ozempic, Rybelsus, Wegovy (semaglutide) Mounjaro, Zepbound (tirzepatide) or of and 4. Where are you purchasing your GLP's or Peptides from currently? (if any) *5. How would you rate your current knowledge and skills with Peptide and Longevity Therapies? * Excellent, I could be a trainerDecent, I know a lotNeutralFair, I know a littleNo knowledge at all How would you rate your Peptide and Longevity knowledge currently today?Excellent, I could be a trainerHow would you rate your Peptide and Longevity knowledge currently today? Excellent, I could be a trainerDecent, I know a lotHow would you rate your Peptide and Longevity knowledge currently today? Decent, I know a lotNeutralHow would you rate your Peptide and Longevity knowledge currently today? NeutralFair, I know a littleHow would you rate your Peptide and Longevity knowledge currently today? Fair, I know a littleNo knowledge at allHow would you rate your Peptide and Longevity knowledge currently today? No knowledge at all Explain or add details: (optional)6. Are you interested in learning more about how to bring peptides into your practice? Or expanding which peptides you currently offer? *Yes - I would like to speak with a specialist to discussYes - I am interested in Peptide and Longevity TrainingsYes - My practice is already offering GLP's / other introductory peptides, and I am interested in expanding or offering more.Maybe - Before going further, I'd like to speak with someone to learn more or receive additional info on peptide therapyNot at this time, maybe later down the road.No*Check one or more optionsExplain or add details: (optional)7. Are you interested in attending our Peptide Longevity Therapies Training in April / May? *Yes, put me on the list to be notifiedNot right now, but maybe in the futureNo8. Which type of peptide training most interests you? (check all that apply) *Introductory Foundation - Longevity & Peptides 101Already familiar, looking to expand - Peptides 202Already offering GLP's, looking to expand - Peptides 202How to launch peptides in your practice, establishing structured systems, business development and pull-through patient marketingNot interested in trainingOtherExplain or provide details: (optional)9. What format would you prefer for Peptide Longevity Training? (check all that apply) *Live with trainer on Zoom with Q&AVirtual recording on demand (so I can watch at my convenience)Live in person with trainer at a training location near me.On site in my practiceNot interested in trainingOtherPlease explain or provide details: (optional)10. Where are you currently receiving your knowledge, research, or training on Peptide/ Longevity clinical and business integration?Example: social media, google, any training organizations or resources. Please explain. YOUR CONTACT INFORMATION: Stay updated on new announcements, products and training opportunities. *We will never spam you, or sell your personal information to a 3rd party. Opt out at any time. Your Full Name *FirstLastCompany Email Address *Mobile Phone to be notified of products and trainings *Your Company Name *Company Website / Domain *Zip Code where your business is located *Do you have any other feedback or interests you would like to share with us? (optional)Submit
