Penny Sampler, Hemp Wellness Advocate
Occupational Therapist MSOTR/L, CBD Advocate & Coach
Could CBD Work For You?
The following questions will help to best address your health concerns. After completing, I will personally text you and recommend products to best address your symptoms. I am not a doctor. I have many years in medical industry treating patients, finding my way with my own chronic illness and 5 years of being a Certified Hemp Wellness Coach. If you have any medical concerns, please address them with your doctor. I'm looking forward to working with you!
First Name
*
Last Name
E-Mail
*
example@example.com
Phone {text only}
*
xxx-xxx-xxxx
Preferred Communication:
*
Text
Email
How did you find me? Who may I thank for your referral?
What is your Instagram handle?
Follow me! @becoming_natural_
I am interested in CBD FOR:
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Myself
Spouse
Child
Pet
Age of patient:
*
0-12 years
13-21 years
22-40 years
41-65 years
66+ years
Sex:
Female
Male
What are Your Health Concerns?
Help me understand your needs best so I can make the best product recommendations to treat your whole body.
Please check all that apply:
*
Frequent
Sometimes
Never
Sleep Issues
Pain
Gut Health
Lack of focus
Anxious feelings/Stress
Mood Swings
Female Issues
Sports Recovery
Attention/Behavior
Signs of Aging
Overall Wellness
How long have these symptoms been occurring?
(Is this a chronic issue or temporary?)
Do you take any prescription or over-the-counter medications or supplements?
(If yes, please list.)
Do You Have Other Concerns You Would Like to Share about your health?
I operate under HIPPA requirements. No information shared with me will ever be shared.
Have you used CBD before? If so, what were your results, what products did you use and why did you quit?
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I love reading labels! This helps me to determine why something may or may not have worked for you.
Do you have a budget? Sometimes more than one product can help healing from inside out and outside in for best results. *As a new customer, I'm able to get you started with 2 full sized CBD products for only $99 (45% off)!*
*
Please recommend a single product for the most benefit ($60-$70)
I am interested in the $99 Discounted Bundle 💚
I want it all and will do what it takes to feel better. Please give me all the recommendations
Do you have any issues with a small, legal, non-intoxicating amount (0.3%) of THC in your products? You may wish to avoid this if you are routinely drug tested for any reason.
*
Yes. I am drug tested on a regular basis and understand that testing is not standardized and would like to steer clear of anything with THC.
No. I am OK with a small, legal amount of THC to receive maximum benefit.
CBD comes in the form of tinctures, which need to be held under the tongue for 30-60 seconds, or edible jellies. Do you have a preference?*
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Jellie
Tincture
Both
No preference
While the effects of CBD are occasionally seen quickly, it's not uncommon for it to take weeks or months to experience results depending upon your issues and severity of symptoms. Are you willing to give CBD a minimum of 8-12 weeks of consistency?*
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Yes. I am willing to take it consistently.
I will try, but I'd rather pop a pill
If you could earn product credit and commission by sharing CBD with friends and family, would that be something you want to learn more about?
*
Yes, I love discounts!
No, I don't need the discount
Maybe in the future
Do You Know CBD Can Work For Your Pets Too?
Anything with a spine has an Endocannabinoid System and benefit from CBD as well.
Do You Have a Cat or Dog?
If you have pets, do they experience:
Yes
No
Anxious with thunder, car rides, fireworks, groomer, visitors to home
Joint & Mobility Issues
Digestive issues
Lack of socialization
Signs of Aging
Overall Wellness
Please add my email to your list for more education regarding the benefits of Hemp and Botanical Wellness
*
Yes, please! (you can unsubscribe any time)
No, thank you
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