WELLNESS QUIZ
I am so happy you are here. These questions will help me get to know you a little bit better. Thank you for taking a few minutes to fill this out.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What's your IG Handle? I would love to follow you.
Are you currently experiencing any of the following? Check all that apply
Bloating
Digestive Issues
Weight Gain
Low Energy/Fatigue
Brain Fog
Trouble Sleeping
Hormonal Issues
Anxiety
None of the Above
Are you currently satisfied with your skin?
Yes
No
Could be better
Are you experiencing any of these common skin issues? Check all that apply
Signs of aging
Fine lines/wrinkles
Dark spots/uneven skin tone
Dry Skin
Oily Skin
Acne
Dull skin/lacking glow
None of the above
Are you familiar with ingredients in your wellness and beauty products and how they can affect your overall health?
I am familiar but I don't really care
I am somewhat familiar but could use more info
I am an avid label reader and all about a low-tox life
I am not familiar with how ingredients affect my overall health
Are you familiar with gut health and how this can affect overall health, your skin and your mental health?
I am familiar but could use more info
Yes! I am a gut health enthusiast
No
What areas of your life would you like to improve? Check all that apply
Overall health & wellness
More community/friendships
More income/financial stability
Mindset/Mental Health
Are you open to hopping on a quick 15 min consultation call to discuss your survey?
Yes! Let's figure out a time best for both of us?
Submit
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