We've detected that Javascript is not enabled. It is required for an optimal survey taking experience.
Please check your browser's settings and make sure Javascript is turned on. Learn how to enable Javascript.

Surveys should never ask for any sensitive or secure data. Do not provide passwords, credit card numbers, identification numbers, or other sensitive information. Report Abuse.

Skip survey header

Share your Healthways FIT story

Contact info

1. First name: *This question is required.

2. Last name: *This question is required.

3. Email: *This question is required.

4. Zipcode:

5. Date of birth:

6. Do you use social media? If so, please provide a link to each of your profiles so that we can connect with you!

Facebook:
Twitter:

7. Are you currently a SilverSneakers member? *This question is required.

Yes
No
Am I eligible?
Other Please enter an 'other' value for this selection.

8. How did you first hear about SilverSneakers?

My friend/spouse referred me.
My insurance company sent me something in the mail.
My insurance company told me in person.
My gym told me in person.
I found it online.
Other Please enter an 'other' value for this selection.

9. How long have you been a SilverSneakers member?

Less than a year
1 - 2 years
3 - 5 years
6+ years!!
Other Please enter an 'other' value for this selection.

10. Health plan:

Survey Software powered by SurveyGizmo