CBD/ Hemp Wellness Questionnaire
Before you get started please know that this is only between us!
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Best phone number to reach you
-
Area Code
Phone Number
Email
example@example.com
Best way to connect with you
Phone Call
Email
Text
How did you learn about me?
Friend
Facebook/ Instagram
Current client referral
In person event
Other
Have you ever tried Hemp/ CBD before?
Yes
No
If yes, did you get the results you were hoping for? Please explain.
Please list the problem(s) which you are seeking help?
Current Symptoms regarding your health (check all that apply)
Athletic recovery (gain and repair) and maintenance
Nervousness, sadness/ mood issues
Sleep issues
Pain
Gut issues
Thinning hair/ skin/ nails, signs of aging
Stress
Lack of energy and focus
Interested in using hemp/ CBD as a prevention/ wellness tool
Other
Other issues you or your loved ones are having?
Do you typically buy organic products?
Yes
No
Sometimes
Do you have budget concerns? (I may recommend 2 or 3 products initially in combination for optimum results)
I am willing to consider multiple product recommendations
Please recommend a single product for the MOST benefit
I want to hear ALL the options
Hemp Wellness is not an overnight fix. It's very important to be consistent when first starting for at least the first 90 days. Can you dedicate 90 days for your best health?
Yes
No
Current Weight
Current Height
Is drug testing a concern for you? If so, please explain. (None of our products will ever cause a high.)
Did you know pets can benefit from hemp/ CBD too?
All mammals have an endocannabinoid system and can reap the benfits of plant based wellness!
Do you have pets?
Dogs
Cats
Other
Do your pets have any of the following?
Nervousness during vet or grooming visits, car rides, storms, or fireworks?
Joint and mobility issues
Digestion and appetite issues
Coat and skin issues
Lack of focus during training sessions
Fear based behaviors related to lack of proper socialization
For pet athletes: endurance gain and recovery
What other concerns might you have regarding your pets?
Are you open to learning more about owning your own wellness business that can enable you to have more time freedom to do the things you love?
Yes, I would like to consider developing another stream of income where I could run a part time/ full time/ any time business from my home or phone
Maybe, I would like to learn more about how I can cover the cost of my own or my family's products
Yes, I would like to become part of a community of wellness advocates that work in service to others
Not at this time but I may want to consider this option in the future
No, this not a viable option for me
Please feel free to share any additional information that may help me understanding how best to serve you, your family, and pets
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