Tell Me About You!
Angela Grondahl | angelagrondahl@outlook.com | angelahealthfanatic.com
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Lets connect on social media. What is your facebook or instagram name?
List Facebook and Instagram Name Here
Age
18-25
26-34
25-44
45-54
55-64
65+
What are you struggling with? Select all that apply.
Energy
Weight loss
Sleep
Skin Issues
Better digestion
Blood Sugar
Inflammation
Headaches / Migrains
Cholesterol
Blood Pressure
Sugar Cravings
Joint Pain
Heart Burn
Anxiety/Depression
Other
Please rate your readiness for change, 10 being the highest.
1
2
3
4
5
6
7
8
9
10
Timeline for achieving your goal:
Rows
2 months
4 months
6 months
8 months
10 months
1 year
Now
Your membership comes with a referral link! Which of these is of most interest to you?
Get my products paid for
Earn $100/month
Earn $300/month
Earn $500/month
Earn $1000+/month
No thanks
Does the opportunity to earn free trips & gifts interest you?
Yes!
No thanks
What questions do you have for me? Or, is there anything else you'd like me to know?
Thank you for taking the time to fill out the questionnaire! I will be in touch with you shortly! 😊
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