{"type":"text","name":"__generic9","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}

• Number of Employees: 

5-20 21-50 51-100 100+{"type":"radio","name":"__generic10","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"5-20\n21-50\n51-100\n100+"}

3. Current Challenges 

(check all that apply) 

High turnover/retention issues High number of Sick days or Medical Leave Team exhaustion or depletion Rapid growth concerns Culture/morale challenges Leadership sustainability Work-life balance issues Other{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"High turnover/retention issues\nHigh number of Sick days or Medical Leave \nTeam exhaustion or depletion\nRapid growth concerns\nCulture/morale challenges\nLeadership sustainability \nWork-life balance issues \nOther"}

If you checked "Other," please specify:

4. Previous Wellness Initiatives

What workplace wellness approaches have you tried? 

(check all that apply) 

On-site wellness services (massage, yoga, etc.) Mental health apps or EAP programs Wellness workshops or lunch-and-learns Flexible work arrangements Team building activities Leadership training Stress management programs Nothing formal yet Other{"type":"checkbox","name":"__generic13","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"On-site wellness services (massage, yoga, etc.)\nMental health apps or EAP programs \nWellness workshops or lunch-and-learns \nFlexible work arrangements \nTeam building activities \nLeadership training \nStress management programs \nNothing formal yet \nOther"}

If you checked "Other," please specify:

What were the results? 

Temporary improvement No noticeable change Some benefit but not sustained Made things worse Mixed results Too early to tell{"type":"checkbox","name":"__generic15","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Temporary improvement \nNo noticeable change \nSome benefit but not sustained \nMade things worse \nMixed results \nToo early to tell"}

What was missing from these approaches? 

{"type":"textarea","name":"__generic16","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"Optional"}

5. What prompted your interest in Third Opinion MD? 

6. Timeline 

When would you like to address these challenges? 

Immediately Within 1-3 months Within 3-6 months Planning for next year{"type":"radio","name":"__generic18","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"Immediately\nWithin 1-3 months \nWithin 3-6 months \nPlanning for next year"}

7. Program Interest 

3-month pilot program 6-month transformation 12-month partnership Not sure - let's discuss{"type":"radio","name":"__generic19","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"3-month pilot program\n6-month transformation\n12-month partnership\nNot sure - let's discuss"}

8. How did you hear about us? 

{"type":"textarea","name":"__generic20","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

9. Additional Information 

Anything else you'd like me to know before our call? 

{"type":"textarea","name":"__generic21","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

Scheduling Note:

If you don't see a time that works on the scheduler, please list 2-3 dates/times that work better for you: