Toxinfree Living

Let's start discovering toxin-free living

Thank you for taking the next step and putting you and your family first. I know that wanting to be healthier goes so far beyond food consumption and I hope that our time together has made you realize that too. I can't thank you enough for taking time to answer these questions. The following questions will allow me a chance into your personal environment and get a better understanding of how I can help and what safe swaps I can recommend for you.
Name *

First Name Last Name
Email- if you want to sign up for freebies and more
shari@sharismyth.com
Instagram name *
@sharismyth
Facebook Name

First Name Last Name
Phone Number *
Please enter a valid phone number so I can communicate- I will be responding from a 302 number
Are you located in the USA or Canada? *

Yes No No but I plan on using a 3rd party shipping service or a forwarding address because I want to be toxin-free!
How would you like to receive your personalized results? *
If I don't get a response with your selected form I will try one other before moving on to help someone else.
What products are you interested in? Check as many as you need to fit your needs. *

Cleaning Laundry Skincare Makeup Bath and body items Gut health Weight Release
What are you currently using for the products that you want to swap? *
Example- Detergent- Tide, Bath soap- Dove, Toothpaste- Colgate ect please be as detailed as possible and even include items for others in your home
What is more important to you in regards to going toxin-free? Select all that apply. *

Quality High performance Affordability Scent
If you selected Gut health or Weight release are you open to filing out a health form?

YES! Not at this time
What factors are motivating you to go toxin free? *
What are your current conditions or health concerns or things you are looking to change. Also what would you like from me in regards to those things (ex. you are on medications for high blood pressure and want help coming off of them in addition to reducing your toxic exposure to help externally reverse your HBP).
Please be as detailed as possible this is a safe space
If you selected makeup/skincare, what does your current routine look like?

I don't have a routine I'm not sure what to use What I am using isn't working- I am not seeing results I spend a lot of money and not happy with current selection I go all out on my skincare My current routine isn't clean and I would like to change that asap Other
Is your skin typically normal, dry, oily or combination?

Normal Dry Oily Combination
Check all the boxes that apply to your skin

Wrinkles/fine lines Acne/blemishes Scarring Sun spots Redness Uneven skin tone Texture Large pores Sensitive Other
17. How often do you wash your face?

Twice a day Once a day When I think about it Every two-three days
17. How often do you exfoliate your face?

Twice a day Once a day When I think about it Every two-three days
17. How often do you use a facial SPF?

Every. Single. Day A couple times a week When I use sunscreen When I know I will be outside a long time I rarely wear a facial SPF Never. Is that important?
What DO you like about your current cleaning/laundry products *
BE AS DETAILED AS POSSIBLE
What DON'T you like about your current cleaning/laundry products *
BE AS DETAILED AS POSSIBLE
What DO you like about your current Makeup/Skincare products *
BE AS DETAILED AS POSSIBLE
What DON'T you like about your current Makeup/Skincare products *
BE AS DETAILED AS POSSIBLE
What DO you like about your current Bath and body products *
BE AS DETAILED AS POSSIBLE
What DON'T you like about your current Bath and body products *
BE AS DETAILED AS POSSIBLE

Please rank what you look for in order of importance when selecting products? *

	1 - Not Important	2	3 - Maybe	4	5 - Very Important
Quality
Cost
Brand name
Familiarity
Efficiency

Would you be open to a monthly subscription box that allows you to customize YOUR needs, give you a chance to get free products, no product waste. That is toxin-free, affordable and value for your hard earned money? *

Sign me up More information please I'm not fully committed to going toxin free just curious No thank you I like wasting money and not being sure what is in my products
Is there anything else that I can help you with today that I may not have touched on? This is simply a safe space for you to add anything you may have thought of while completing this, or any additional comments or concerns and if you selected other for anything above you can go into detail further here. Thank you so much for your time today. Look forward to connecting further.
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Let's start discovering toxin-free living