Vybe Holistic + Healthy Living Collective
Name
First Name
Last Name
Email
example@example.com
IG handle
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Whats your favourite form of communication?
IG
Text
Phone
Email
Is a maintaining healthy lifestyle important to you?
Yes
No
Somewhat
What daily activities are important to you for your overall health? Check all that apply.
Exercise/movement
Tapping, Meditation, etc..
Nutrition
Water
Stretching/Mobility
Lymphatic Drainage
Other
Do you exercise?
Yes
No
Sometimes
What type of exercise do you enjoy? Check all that apply.
Weight Lifting
Walking
High Intensity Training
Pilates
Sports
Yoga
Other
Do you have a practice to support your emotional well being and nervous system?
Yes
No
Not sure?
If yes, which practices do you use? Check all that apply.
Tapping
Meditation
Time in Nature
Journalling
Gratitude
Sound Healing
Breathwork
Counselling/Talk Therapy
Other
If no, how come?
No time
Not a priority
Not sure what to do
Do you know what lymphatic drainage is?
Yes
No
Do you work with your lymphatic system?
Yes daily
Yes sometimes
I go for lymphatic massage
No
Are you currently experiencing any of the following? Check all that apply.
Bloating
Digestive issues
Low energy/fatigue
Autoimmune disorders
Anxiety
Brain fog
Fertility issues
Trouble sleeping
None of the above
Do you currently take supplements to support your health?
Yes I am stacked
I take a couple things
Not sure what I should be taking
No
Are you currently satisfied with your skin?
Yes
No
Could be better
Do you have a skin care regime?
Yes I love it
Yes but it's not the best
I use a couple things
No
Are you experiencing any of these common skin issues? Check all that apply.
Acne
Oily skin
Dry skin
Signs of aging
Fine lines/wrinkles
Dark spots/Age spots
Dull skin/lacking glow
Eczema
Rosacea
None of the above
Are you familiar with ingredients in wellness and beauty products and how these things can affect your overall health?
I’m familiar but don’t really care
I’m somewhat familiar but could use some more info
I’m an avid label reader and all about that low-tox life
I’m not familiar with how ingredients affect my overall health
I want to help you feel your absolute best! What’s the best way I can share resources with you to address some of these things that might be affecting your overall well being? Check all that apply.
Podcasts and book recommendations
Send me the deets on virtual wellness workshops to learn more
Supplement recommendations to support my well being
Product recommendations for Skin Care
Invite me to local in-person workshops to learn more about low-tox living & sustainable healthy lifestyle hacks
All of the above
Can I add you to my VYBE Holistic + Healthy Living Collective page on Facebook where I share free resources, emotional well being tips, product links, lymphatic drainage tips, discount codes, healthy habits, quick & easy recipes, and virtual & in person connection opportunities for living your healthiest life?
Yes please!
No thanks
I’m ready a member!
Are you open to hopping on a quick 15 min consultation call to discuss your survey?
Yes
No
Submit
Is there anything you would like to share? Anything in particular you would like to see in the Healthy Living Collective?
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