HFH Inquiry Questionnaire

Full Name *

Date of birth *

Email *

Phone *

Gender *

Male

Female

Prefer Not to Say

Address *

Street Address

City

State

Country

Postal Code

Please complete the information below with as much detail as possible. Our team will look over your responses and follow up with the next steps as soon as possible.

Which of the following best describes your story? (Check all that apply) *

I overcame a chronic or rare health condition (Health Warrior)

I transformed my health through fitness, wellness, or lifestyle changes (Wellness Advocate)

I support others through education, coaching, or advocacy (Health Champion)

I’m a caregiver or family member sharing a loved one’s journey

Other: ____________________________

Other:

Please describe your health journey in detail. What did you experience, and what inspired you to take control of your health? *

What was the moment or turning point that changed your perspective or path? *

What treatments, therapies, support systems, or breakthroughs were most helpful to you? *

How has this journey impacted your life, family, or community today? *

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