Wellness Survey with Ally Stiller

Name

First NameLast Name
GRATEFUL YOU’RE HERE

Thank you for taking the next few minutes to answer these for me— Choose whichever options seem like the best fit for you below to give me a better understanding of how you’re feeling & and how I can best serve you as a result, ᵕ̈
Email
example@example.com
Instagram Handle if applicable ᵕ̈
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Rate your typical day-to-day energy level 1-10:
How's your digestion (1-3 solid bowel movements a day? Any Constipation?)
What are your food cravings? Do you currently eat gluten, dairy, processed foods and/or drink alcohol, coffee, energy drinks?
Do you get headaches? If so, how often?
How do you feel waking up in the morning? Check all that apply.
How's your sleep? Do you struggle to fall or stay asleep? Do you use any sleep aids?
Can you think of any specific habits that aren’t currently serving you regarding sleep, mental health and/or nourishment?
Do you have children? If so, how are their eating habits? Are you interested in gut health information for kids? ᵕ̈
Are you pregnant or breastfeeding? If pregnant, how far along? If breastfeeding, how old is your baby?
Are you intentional about how many grams of protein you consume daily or working on having more each day?
Are you currently experiencing any of the following? Within the last month, check all that apply:
Are you currently satisfied with the look and feel of your skin?
Are you experiencing any of these common skin issues? Within the last month, check any that apply:
How familiar are you with ingredients in wellness and beauty products and how they can affect your overall health?
How familiar are you with the importance of gut health? Are you aware of the role it plays in your overall health, skin, and your mental health?
What areas of your life do you feel inspired to focus on right now? Please check all that apply even if it might be more of a longterm priority:
Are you open to or looking for opportunities for more income?
If yes to the answer above, check the income level that would be ideal:
I want to help you! How can I best follow up? ᵕ̈
Should be Empty:

GRATEFUL YOU’RE HERE