Contessa's Wellness Survey
Thank you for taking time to tell me about yourself!
Name
*
First Name
Last Name
Email
example@example.com
IG Handle
Facebook Profile Name
Cell Phone Number
*
Format: (000) 000-0000.
If you already use Arbonne please share your favorite products:
Are you currently experiencing any of the following? Check all that apply.
Bloating
Digstive Issues
Low Energy/Fatigue
Brain Fog
Trouble Sleeping
Hydration
Anxiety
Hormone Imbalance
Blood Sugar Balance
Skin Issues
Weight Gain / Plateau
Weight Loss
Desire to Increase Protein Intake
None of the Above
Do you have health goals you're working on and if so, what are they?
Are you happy with the look / feel of your skin?
Yes
No
Could Be Better
Are you experiencing any of these common skin issues? Check all that apply.
Acne
Oily Skin
Dry Skin
Sensitive Skin
Signs of Aging
Fine Lines / Wrinkles
Dark Spots / Age Spots / Post-Acne Scars
None of the above
Are you familiar with ingredients in wellness and beauty products and how they can affect your overall health?
I'm familiar, but haven't thought about looking into it
I'm somewhat familiar, but could use some more info
I'm an avid label reader and into low-tox living
I'm really 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 info
Yes - I'm a gut health enthusiast
No
What areas of your life do you want to improve? Check all that apply.
Overall Wellness
Creating a 1-2 Easy, Sustainable Healthy Habits
Exchanging My Toxic / Health-Disrupting Products for Clean, Safe Products
Community / Friendships
Personal Growth / Becoming the Best Version of Myself
Extra Income / Financial Security and / or a Career Shift
I'd love to help you! How can I best follow up? Check all that apply.
Let's chat about my goals and what products could be right for me!
Please send product recommendations based on my answers!
Let's get some friends together and sample everything!
I'd love a discount by sharing this survey with friends so you can help them!
I'd love to check out your FREE healthy living tips + recipes on Facebook!
I'd be open to hearing about the benefits of building an Arbonne business!
I'd love to connect with a community of like-minded healthy people
Other
Anything else you'd like to share so I can help you?
The ripple effect! Who do you know?
I am passionate about helping people improve their health! If you would be willing to share this survey with your family and friends, I would love to send you a special thank you gift when I receive their completed information! Let’s spread health and wellness and change the world for the better - one person at a time! Thank you so much!!
If someone besides me (Contessa Bishop) shared this survey with you, please list their name here so I can thank them.
First Name
Last Name
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