The 10-Minute Mindset Audit
Every quarter, we invite extraordinary entrepreneurs to join StartUp Health Moonshot Academy and become lifetime members of our global army of Health Transformers.

To receive your exclusive invitation, please complete The 10-Minute Mindset Audit™ by answering a few questions and selecting the phrases that best describe you, your company and your solution.
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Your Full Name *

Your Company Name *

Your Title *

Your Phone Number *

Your Company Website *

Your Company's Primary Location: *

Please indicate where your company is located.
Co-founders Names, Roles, F/T Status & Bios *

Please list the names of your co-founders, their roles, and indicate if they are full-time or part-time. Don't forget to include LinkedIn Profile links and notable achievements or accomplishments for you and your team!
Your Mindset

Your Commitment *

Your Relationships *

Your Rhythm *

Your Confidence *

Your Self-Awareness *

Your Habits *

Your Future *

Your Energy *

Your Company

Your Company's Story *

Your Company's Team *

Your Company's Brand *

Your Company's Traction *

Your Company's Business Model *

Your Company's Technology *

Your Company's Partnerships *

Your Company's Capital *

Your Product Stage *

Months of runway *


Please provide a link (Dropbox, Google Drive, etc.) to your most recent presentation deck.
Why do you want to join StartUp Health? *

Which "Health Moonshot" are you working to achieve. *

You can select more than one.

Which program are you interested in being considered for? *

Currently accepting submissions for the StartUp Health Moonshot Academy!

Your Solution

Your Solution's Target Customer & Traction *

Your Solution's Disease Specialty *

Your Solution's Health Spectrum Focus *

Your Solution's Workflow *

Your Solution's Analytics & Value Based Care *

Your Solution's Technology *

Your Solution's CHP Integration *

Your Solution's Revenue Share Potential *

Thank you for completing The 10-Minute Mindset Audit™!

If you have any questions, please email us at