Swoon Juice Bar : Wellness Survey
Let’s create a wellness plan together.
Name
*
First Name
Last Name
Please share your address so that we can mail you samples!
*
Mailing Address
City
State
Zip
Instagram profile name (so we can follow you!)
Facebook profile name (so that we can add you to our Healthy Living Community!)
Text Number
*
We will send you some great product videos and suggestions 😃
Format: (000) 000-0000.
What areas of your life/health are you most concerned about or interested in? (check any that apply)
*
3 or 5 Day Juice Reset
information about a 30 Day Reset
Ingredients and how they impact our health
Intermittent fasting
Weight loss
Hormone balance and menopause
Sleep issues
Immune system
Skin Care (acne, oily or dry skin, age spots)
Anti-aging
Eczema or Psoriasis
Blood sugar balance
High blood pressure
HDL/LDL
Depression/Anxiety
Stress
Low energy/fatigue
Digestive issues/Gut health
Brain fog
Injury recovery and healing
Joint pain
Sports nutrition
Nutrition/skin ideas for kids and teens
I am interested in purchasing a bag of protein for use at home
Other
Are you currently working on any specific health goals?
We want to help you grow in your healthy living journey! (Check all that apply)
*
I’d love to get recommendations based on my health concerns and interests.
I’m interested in creating some simple sustainable healthy habits!
Let’s get a few people together in person to sample everything!
I have some friends that I could share this survey with.
I’d love an invitation to the healthy living community on FB.
Please send me info on how to earn a little extra $ by sending out surveys to my connections.
Please tell me about ways to save and earn free products monthly.
What time of the day in the next couple of days would work for a 15 minute follow-up chat.
Between 9am to noon
Between noon and 5pm
Between 5pm to 9pm
What time zone are you in?
Please Select
Alaska
Pacific
Mountain
Central
Eastern
What else should we know about you?
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