Whitney Ray's Wellness Form

Whitney Ray's Wellness Form

Thank you for taking a minute to fill this out! xo Whitney Ray 281-352-8661
Name

First NameLast Name
E-mail
example@example.com
IG handle
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Which of the following are you currently experiencing? (Check all that apply):
How would you describe your current wellness routine?:
What are your top skin or makeup concerns right now? (Check all that apply)
How would you describe your current skin care routine:
How would you describe your current makeup routine:
Are you familiar with ingredients in wellness and beauty products and how these can impact your overall health?
What areas would you most like to improve in the next 90 days? (Check all that apply):
Other:
On a scale of 1-5, how ready are you to make changes to your health/beauty routine in the next 30 days?

1

2

3

4

5

1 is Not Ready, 5 is Let's go!
Would you be open to a quick 15-minute call to review your results?
Should be Empty: