SHIFT into Wellness Quiz

SHIFT into Wellness
Name

First NameLast Name
Email
example@example.com
IG handle
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I would like to improve these types of things in my life, health and body

Reduce Stress and Less AnxietyEstablish Healthier RoutinesFind Balance with Work and FamilyLose Weight and eliminate bloating
Are you currently experiencing any of the following? Check all that apply.

Digestive issues, BloatingLow energy/fatigueAnxiety/ stressBrain fogTrouble sleepingBurned outOverwhelmedSkin is dull, and agingPeri menopausal, MenopausalOther
What are you currently doing to achieve your goal?

Nothing at the momentI've been thinking aboutReady to take the next steps
Was it the appeal of SHIFT into Wellness for you?

Looking for a transformational changeI need to establish healthier habitsI need a healthier gut and to be happy
I want to help you in any way i can! How can i best follow up?! Check all that apply

Product recommendation for your overall wellnessMini consultation to go over my concernsReady to get started
What areas of your life would you want to improve? Check all that apply

More community and accountabilityMindset & Mental healthGut health resetWeight LossSkin care
Are you open to learning more?

Group coaching & AccountabilityIndividual coachingSelf paced challengesGut health resetWorkshops
Are you open to hopping on a quick 15 minute consultation call to discuss your survey?

ASAPWeek daysWeek nights
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