Executive Longevity Application

Recovering Wellness Executive Longevity Membership Application

Confidential preliminary assessment

Because membership is intentionally limited, each application is reviewed individually. Please complete the questions below as thoroughly as possible. Qualified applicants will be contacted to schedule an Executive Health Consultation.

Estimated completion time: 7–10 minutes

Executive Longevity Membership Application

Q3: Current health rating

Excellent

Very good

Good

Fair

Poor

Q8: Function Health-Have you previously completed Function Health testing?

Yes

Not yet, but I am willing to complete it

Q9: Commitment level-How committed are you to making meaningful changes to your health over the next 12 months?

10 — Fully committed

8–9 — Very committed

6–7 — Interested but may need support

5 or below — Not yet certain

Q10: Biggest obstacle-What is the biggest obstacle currently preventing you from reaching your health goals?

I do not know exactly what to do

Lack of accountability

Lack of time

Pain or physical limitations

Stress and competing responsibilities

Inconsistent habits

Previous approaches have not worked

Financial concerns

Other

Q11: Readiness for a personalized plan-Are you willing to follow a personalized plan involving nutrition, movement, recovery, supplementation, coaching, and in-office care?

Yes

Possibly—I would like to discuss it

Q12: Investment qualification-The annual investment is $12,000 paid in full or $1,250 per month. Which statement best describes you?

I am prepared to invest if the program is the right fit

I would like to understand the program before deciding

I would need to discuss the investment with my spouse or partner

I am not currently prepared to make this investment

Q13: Decision-making - Will anyone else be involved in your decision to join?

No, I can make the decision myself

Yes, my spouse or partner

Yes, another family member

Yes, a business partner or advisor

By submitting this application, you acknowledge that this is a preliminary membership assessment and does not establish a doctor-patient relationship or guarantee acceptance. The Executive Longevity Membership is intended to support proactive health optimization and does not replace primary care, emergency services, diagnosis, or treatment from an appropriately licensed medical provider. Please do not submit urgent or highly sensitive medical information through this form.

Recovering Wellness Executive Longevity Membership Application

Executive Longevity Membership Application

Join Our Free Trial