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Name
First Name
Last Name
Phone Number
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Email
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What are you seeking help for? (Select all that apply)
Mood issues (could be anxiety, depression, overstimulation, anger, irritability etc)
Stress levels/ overwhelm/ high cortisol
Focus/ energy
Sleep
Pain
Gut health
Post partum
Immune support
Hair/ skin/ nail health
Inflammation
Other
Biggest concern:
Please elaborate on the issues you’re dealing with. Are they chronic or acute? How long have you been dealing with them? Has anything else worked in the past? Anything else I should know?
Have you used CBD before? If so, tell me a little bit about your experience. How were your results? What brand/product did you try, etc.?
Do you have any concerns with a small (LEGAL), NON-intoxicating amount of THC (0.3% or less) in your products? You will not feel psychoactive effects, just medicinal benefits (AKA extra support) *you want to avoid this if you’re routinely drug tested.
I have no issues with THC. Whatever will give me the best benefits.
I perfer THC free
There are 2 ways to take CBD - tincture (oil form) or jelly (gummy) form. Jellies hit your system faster. Which do you prefer?
Jellies
Oil
No preference
Some people will notice a difference quickly within a couple of days. However, it’s not uncommon for it to take several weeks to fully experience results. Are you willing to give CBD a minimum of 6-8 weeks of consistency, and allow me to coach you through your dosage?
I’ll try my best!
Yes! Not looking for a quick fix, looking for long term.
I’m willing to give it a full month
Are you interested in CBD for anyone else in your family?
My spouse
My kid (s)
My pet (s)
Other
Anything else I need to know or questions you have?
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