Customer Needs Assessment
Please answer this form so I can assist you in products that may benefit you and your lifestyle.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Supplements
Do you or would you like to start taking daily vitamins?
Yes
No
If yes, do you have issues with tablet vitamins and need gummies?
Yes
No
Do you prefer tablets or gummies?
Tablet vitamins
Gummy vitamins
I like both
Would you value supplements for: (choose all that apply)
Digestion
Heart health
Bone density/health
Joint health
Vision health or you tend to be on screens a lot
PMS/Cycle Support
Iron deficiency
Arthritis
Energy
Stress
Sleep
Immunity
Allergies
Hair, skin, & nail health
Prenatal
Sports Nutrition
Do you drink energy drinks?
Never
Occasionally
A couple times a week
Daily
Would you be interested in a caffeine free energy drink? (Contains B vitamins for energy & natural fruit juices)
Yes
No, stick with caffeinated (also contains b vitamins and natural fruit juices)
None
What flavors would you choose when it comes to energy drinks? (Choose all that apply)
Citrus
Black cherry cola
Cranberry grape
Tropical
Wild berry
Root beer
Classic
Naranja (Orange)
Summit (like sprite)
Watermelon lemonade
Mango pineapple guava
Lemon
Blue razz
Kiwi strawberry
Dragon fruit
Pink grapefruit
Would you be interested in protein powder?
Yes
No
Would you be interested in pre-made protein drinks?
Yes
No
What type of protein do you prefer?
Whey Protein
Grass-Fed Whey
Organic Plant Protein
No Preference
If yes, what flavor do you lean towards?
Chocolate
Vanilla
Strawberry
All Of The Above
Do you currently have any personal weight loss goals?
Yes, lose weight
Yes, gain muscle
Yes, both
Yes, maintain
None
Do you use or would like to use any workout products like recovery, pre-workout, or hydration? (Choose all that apply)
Recovery
Pre-workout
Hydration
No
Skin Care
Do you currently have any skin care concerns? (Choose all that apply)
Dull skin
Uneven skin tone/dark spots
Fine lines & wrinkles
Loss of firmness & elasticity
Dry skin
Oily skin
Sensitive skin
Visible pores
None
Beauty
Do you wear makeup at all?
Yes
No
Is there anything you’re currently in need of or would like to learn more about : (choose all that apply)
Foundation
Tinted moisturizer/ cc cream
Concealer
Blush
Bronzer
Eyeshadow
Eye liner
Lipstick
Lip gloss
Mascara
Waterproof Mascara
Nothing at the moment
What is your skin type?
Oily
Dry
Combination
Personal Care
When it comes to your hair what do you focus on? (Choose all that apply)
Moisture
Breakage/Anti-Hair Fall
Anti-Dandruff
Purifying
Intensive Repair
2-in-1 Shampoo & Conditioner
When it comes to body wash what do you focus on? (Choose all that apply)
Hydration
Exfoliating
Prefer bar soap
When it comes to body lotion what do you focus on? (Choose all that apply)
Deeply Nourishing
Light Weight
Unscented
Would you value plant based oral care products?
Yes
No
Children
Do you or someone you know have toddlers or children and would value: (choose all that apply)
Great nutrition
Vitamins
Safe body care
Immunity supplements
Household Products
Would you value high quality, environmental friendly kitchen/dish cleaning products?
Yes
No
Would you value high quality, environmental friendly, high concentrated surface cleaner proven to kill the coronavirus that cause Covid 19?
Yes
No
Would you value high quality, environmental friendly bathroom cleaning products?
Yes
No
Would you value high quality, environmental friendly laundry cleaning products?
Yes
No
Miscellaneous
Would you value agriculture products that help crops, house plants, or even your lawn grow and thrive?
Yes
No
Are you in need of or would like more information about : (Choose all that apply)
E-Spring (Water Treatment/Filter)
Air Purifier
Cookware
Is there anything you are currently in search or need of?
Submit
Should be Empty: