Name
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How concerned are you about the overall wellness of yourself or someone you love?
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1
2
3
4
5
Have you used plant alternatives before?
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Yes
No
Yes, but without desired success
Do you struggle with
Sleep
Mood
Anxious Feelings
Sadness
Brain fog/focus/concentration
Inflammation/Pain
Migraine headaches
Chronic Stress
Frequent Sicknesses
Bloat
Libido
Metabolism
Do you have a specific concern not listed?
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If you use CBD products currently, what does your routine look like?
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Are you interested in a detailed explanation of what products I recommend and how they will improve your quality of life and decrease or eliminate the issues selected above?
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Yes, DM me!
No
Are you currently or have you ever tried
9D Breathwork
Talk Therapy
Hypnosis
EMDR
Are you currently experiencing
Guilt and/or shame
Grief & Loss
Stress & Anxiousness
Fear
Rage
Money Blocks
Stuck in the past
Worn out by life
Trauma or past trauma
Lack of Motivation
Other
Instagram Username and-or phone number
Email
*
I'm interested in
*
Purchase Products
Shop at an advocate discount
Partner with me & make an extra income
Other
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