Wellness Survey

1

Name

First Name

Last Name

2

Email

example@example.com

3

IG handle

4

Phone Number

Please enter a valid phone number.

6

Are you currently satisfied with your skin?

Yes

No

Could be better

8

Are you familiar with ingredients you're consuming and in your wellness and beauty products? Do you know 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

9

Are you familiar with gut health and how this can affect your overall health including your skin, hair, immune system and mental health?

I’m familiar but could use more info

Yes! I’m a gut health enthusiast

No

10

What are some of your overall wellness goals? How can I support you? Check all that apply

Product recs for your skin or overall wellness

Nutrition coaching

Healthy recipe ideas

Send me samples of things that might help!

At home workouts

Add me to your VIP group so i can access info on these topics

11

What areas of your life would you want to improve? Check all that apply

Overall wellness

More community/friendships

More income/financial stability

Mindset/Mental health

Physical Fitness

12

Are you open to jumping on a quick 10 minute consultation call to discuss your survey?

Yes!

Not right now