Healthier You in 2026
leahvanvoorst@gmail.com
Full Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What’s your level of daily movement?
Not very active
Slightly active
Moderately active
Highly active
How would you rate your stress levels?
Not at all stressed
Somewhat stressed
Very stressed
Type option 4
How many hours a night do you sleep?
8-10
6-8
Less than 6
Type option 4
Your current diet could be best characterized as:
Low fat
High protein
Vegetarian/Vegan
No special diet
What are some of your health goals?
Better energy
Weight loss
Stronger skin/hair/nails
Better sleep
Better digestion
Better immune health
Clearer Skin
Better focus
Better nutrition
Other
Please rate your readiness for change with 1 being that you’re not ready and 10 that you’re fully committed to change
1
2
3
4
5
6
7
8
9
10
Timeline for reaching your goal
Rows
Now
8 weeks
16 weeks
24 weeks
32 weeks
40 weeks
Which one applies to you
Are you currently working with a Plexus Ambassador?
Yes
No
Is there anything else you’d like me to know?
What is the best way to reach you?
Phone call
Text message
Facebook
Instagram
Email
Please provide the best way to reach you here👇
Back
Next
Are you able to commit to investing $120 or more in your own products?
Submit
Should be Empty: