Tell me about yourself
I'm so glad you're here! This quick survey is designed to help me get to know you—your health goals, wellness struggles, and what support you need to feel your best. Whether you're looking for more energy, better digestion, glowing skin, or just simple, sustainable habits, I’ve got you covered! It only takes 2-3 minutes and will help me support you in the best way possible. Let’s get started! ⬇️
Name
First Name
Last Name
Email
example@example.com
Phone number (optional)
How did you hear about me?
Please Select
Market or community event
Social media or online event
Sample or freebie
Referral from a friend
Aspen Creek Skincare Clinic
If referred from a friend, please enter their name here
Occupation
What are you health and wellness goals? (check all that apply)
More energy throughout the day
Improved gut health and digestion
Clearer skin and healthier hair
Support weight management
Better sleep and stress management
Hormonal balance (managing cortisol, reproductive health, etc)
Building lean muscle and strength
Sustainable healthy eating habits
Switching to non-toxic products
Managing menstrual cycle symptoms
Better vaginal health (relief from bacterial imbalances, UTIs, etc)
Dry scalp, dandruff
Weak, brittle or oily hair
Menopausal symptoms (night sweats, mood swings, fatigue, etc)
Other
What is your biggest struggle when it comes to your health and wellness?
Knowing where to start
Staying consistent
Finding time
Managing cravings and emotional eating
Understanding what's actually health vs. marketing hype
Finding a routine that works with my budget
Other
Are you experiencing any of these common skin issues? Check all that apply.
Dryness or dehydration
Acne or breakouts
Hyperpigmentation or dark spots
Redness or sensitivity
Fine lines/wrinkles
Uneven texture or dullness
Eczema
Rosacea
None of the above
Other
How do you prefer to receive wellness tips, product recommendations, and exclusive offers?
Text
Email
Instagram DM
Whatsapp
Instagram or FB DM
Other
What is your biggest hesitation when it comes to investing in your health and wellness?
Time commitment
Cost
Fear of not seeing results
Not sure where to start
I don't have any hesitations
Other
If you could have ONE wellness win in the next 90 days, what would it be?
On a scale of 1 to 10, how committed are you to making positive changes to your health and wellness?
Would you be open to a free 15-minute consultation to get personalized recommendations?
yes, I'd love that
Maybe, tell me more
Not right now
Would you like to join an online Wellness Collective group where we share tips, information, education and support on all things health and wellness?
sounds great!
send me some more information
not right now
Have you ever thought about earning extra income through an online health and wellness company?
Yes, I've been actively looking for opportunities
I'm curious, tell me more
Love the idea, but not sure I have the time
Not right now
No thank you, just here for the wellness tips
If you could create an extra $500-$1,000/month sharing products you love, would you want to learn how?
Yes, I'd love to learn more!
Maybe, but I have questions
Not right now
Submit
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