Wellness Survey
Kacidra Anderson - thank you so much for taking the time to do this survey! I will get back to you within 24 hours :)
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Instagram handle
Are you currently experiencing any of the following? Check all that apply!
Bloating
Digestive Issues
Low Energy/Fatigue
Anxiety
Brain Fog
Trouble Sleeping
Skin Issues
Weight Loss
Weight Gain
None Of The Above
Other
Are you currently satisfied with the look/feel of your skin?
Yes
No
Could Have Some Improvements
Are you currently experiencing any of these skin issues? Check all that apply.
Acne
Oily
Dry
Fine Lines/Wrinkles
Dark Spots/Age Spots/Acne Scars
Dull skin/Uneven Skin Tone/lacking glow
Eczema
None of the above
Other
Are you familiar with gut health & how this can effect your overall health, skin, and mental health?
I'm familiar, but could use more information
Yes! Gut health is a priority for me
No
What areas of life would you want to approve? Check all that apply.
Overall wellness
More community/friendships
Extra Income/financial stability
Mindset/mental health
I want to help you! How can I best follow up? Check all that apply.
Product recommendations for your overall wellness
Send me samples of products that could help!
Let's chat about what products would be right for me!
How would you like to be contacted?
Text
Call
Instagram message
Submit
Should be Empty: