Wellness Questionnaire
Thank you for taking the time to answer these questions. The following questions are helpful in knowing how we can assist you.
1. Are you looking for an Eco Friendly Brand?
Yes
No
2. Do you have any health concerns?
Please Select
Asthma
Eczema
Diabetes
Fibromyalgia
Rheumatoid Arthritis
Lupus
Sleep Issues
Anxiety
Heart Disease
GI Issues
Arthritis
Memory Issues
Other Issues
3.Where do you currently shop?
Costco
Whole Foods
Trader Joes
Safeway, Frys, Kroger, other big box brand store
4. How old are you?
Under 18
18 - 25
25 - 45
45 or more
5. Gender?
Please Select
Male
Female
Gender Neutral
6. How often do you Exercise?
Please Select
Daily
Once a week
Once a month
Once a year
Never
7. Are you looking for Extra or Replacement Income?
Please Select
Extra income
Replacement income
Not looking
8. How many hours are you able to work PT or FT
Please Select
0-10
10-20
20-40
Not Applicable
We will get back with you Shortly, please let us know the best time to reach you
Please Select
Morning
Afternoon
Evening
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