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18
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1
Are you suffering with hair loss and weight gain?
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2
Are you struggling with any of the following issues?
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Flaky Scalp
Mood Swings
Hair Loss (Alopecia)
Low Energy
Thinning
Weight Gain
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3
Are you experiencing any of the following?
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PCOS
Hormonal Issues
menopause
Gut issues
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4
What is your #1 goal? Hair growth, or weight loss? Explain
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5
What area are you holding weight? Explain
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6
What type of (hair or scalp) problems do you have? Explain
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7
What are your biggest frustration? Hair loss or weight gain? Explain
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8
How does your hair loss or weight gain make you feel? Please Explain
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This is a safe place to talk about your hair or weight trauma.
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9
If you could wave a magic wand, how would you solve your hair or weight issues? Please explain
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.
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10
Want products to solve your hair or weight issues?
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Yes
No
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11
What product would you like best?
In Person Fitness Coaching
Shampoo & Conditioner
Weight loss products/detox
Hair Growth Oil
Online Fitness Coaching
Hair Growth Supplements
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12
Do you want a holistic wellness program that would help you improve your hair, scalp and quality of life?
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If so, what do you need from the coaching program?
Yes
No
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13
First Name
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14
Last Name
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15
What is your age range?
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18-24
25-34
34-44
45-54
55+
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16
How did you find us?
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Instagram
Tiktok
Youtube
Facebook
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17
Mobile Number
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Area Code
Phone Number
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18
Email
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example@example.com
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