Wellness Collective Survey

Form
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
IG Handle
Are you currently experiencing any of the following? Check all that apply.

BloatingDigestive IssuesLow energy/FatigueAutoimmune disordersAnxietyBrain fogFertility IssuesTrouble SleepingNone of the Above
Are you currently satisfied with your skin?

YesNoCould be better
Are you experiencing any of these common skin issues? Check all that apply

AcneOily SkinDry SkinSigns of agingFine lines/wrinklesdark spots/age spotsdull skin/ lacking gloweczemarosaceanone of the above
Are you familiar with ingredients in wellness and beauty products and how these things can affect your overall health

I'm familar but dont really careIm somewhat familiar but could use some more infoIm an avid label reader and all about that low-tox lifeIm not familiar with how ingredients affect my overall health
Are you familiar with gut health and how this can affect your overall health, your skin, and your mental health?

I'm familiar but could use more infoYes! Im a gut health enthusiastNo
I want to help you in any way i can! How can i best follow up?! Check all that apply

Product recs for your skin or overall wellnessSend me samples of things that might help!Add me to your VIP group so i can access info on these topicsType option 4
What areas of your life would you want to improve? Check all that apply

Overall wellnessMore community/friendshipsMore income/financial stabilityMindset/mental health
Are you open to hopping on a quick 15 min call to chat & discuss your survey?!

YesNo
Should be Empty:

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