Beta Test Interest

 
Welcome! To be considered for the Zume Life Beta Test Program, please fill out this short form. Beta Test Program members must reside in the United States and have access to a regular phone line. We will ONLY use this information to help us select participants and communicate with you about the program. Thanks for your interest!
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Please tell us a little about yourself:
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Please provide your email address:
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Gender:
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Please tell us your age range:
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Are you a medical or health care professional?
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What on-going health conditions are you managing (please check all that apply):
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What are the biggest challenges you face in managing your health?
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How would you rate your control of your health?
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How would you rate your own ability to manage your health?
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How informed are you about your condition and treatments?
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How many prescription medications do you take every day?
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How many non-prescription medications do you take every day?
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How many vitamins and/or supplements do you take every day?
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How did you hear about the Zume Life Beta Program? (Please check all that apply)
What interests you about Zume Life?
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