Wellness Survey
Hello, so glad you are here! Thank you for taking the time to fill out this quick survey!! Let’s see how I can help you! Answer a few quick questions so I can get to know you a little bit better :)
Name
First Name
Last Name
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Email
example@example.com
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Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Are you currently experiencing any of the following? Check all that apply.
Bloating
Digestive issues
Low energy/fatigue
Anxiety
Brain fog
Trouble sleeping
Acne
None of the above
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Are you currently satisfied with the current look/feel of your skin?
Yes
No
Could be better
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Are you experiencing any of these common skin issues? Check all that apply
Acne
Oily skin
Dull/Dry skin
Fine lines and wrinkles
Dark spots/age spits/ post acne spots
Uneven skin tone
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Are you familiar with ingredients used in skincare and make up products and how they can affect your health?
I’m familiar, but haven’t really bothered looking into it
I’m somewhat familiar, but could use more info
I’m an avid label reader and low toxic living is very important to me
I’m not familiar with how ingredients affect my overall health
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Are you familiar with gut health and how it can affect your overall health, your skin and mental health?
I’m familiar but could use more info
Yes! I’m a gut health enthusiast
No
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I want to help you! Which way is the best for following up?! Check all that apply.
Text product recommendations for my skin and/or overall health
Send more information regarding gut health
Help me get the best deal on these products
Could I try a sample please?
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What areas of your life would you want to improve? Check all that apply!
Overall Health and Wellness
More community/friendships
Extra income/financial stability
Mindset/mental health
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Are open to hoping on a 15 minute call to discuss your survey answers?
Yes
Not right now
Submit
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