Katie Moore Wellness
Looking forward to connecting and helping you reach your goals!
Name
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First Name
Last Name
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Are you most interested in:
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Nutrition
Exercise
Skincare
Extra Income
Are you experiencing any of the following? Check all that apply.
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Bloating
Digestive Issues
Low Energy
Brain Fog
Trouble Sleeping
Problems with Weight Management
Hormone Issues
Insulin Issues
Other
Are you experiencing any of these skin issues?
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Acne
Fine Lines/ Wrinkles
Dark Spots/ Age Spots
Dry Skin
Uneven Skin Tone
Other
How would you describe your current exercise regime?
Exercise is not a priority to me right now
I want to exercise, but I'm not sure where to start
I used to exercise but have stopped my routine
I have a great exercise routine but would like more variety
Exercise is a normal part of my life, and I'm happy with what I'm doing
Are you familiar with ingredients in your health and beauty products and how they affect your overall health?
I am familiar and use mostly clean products
I am familiar but don't really care
I am somewhat familiar but need more info
I am not familiar
Are you familiar with gut health and how this can affect your overall health, mental health, and skin?
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I'm familiar but would love more info
I don't have a clue - fill me in!
Yes! I know all about it
Which areas of your life do you want to improve?
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Overall wellness
More/ better community
More income/ financial flexibility
Adding healthy habits
Exercise/ fitness
How much additional monthly income would make a difference for you and your family?
$200
$500
$1000
$2500
Would you like to receive my monthly newsletter with favorite playlists, recipes, and wellness resources?
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Sure!
No thanks
Are you open to hopping on a quick 15 minute consultation call to discuss your survey & snag some free samples?
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Yes!
No thanks
Maybe, let's chat over email/ text first
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