Guest Wellness Form

Your Wellness Journey Starts Here!

Please take 1 minute to answer the questions below so I can provide personalized recommendations that best support your goals! - Christina Lamorte Bazin, RVP
Name*

First NameLast Name
Text Number*
I will send a text with recommendations based on the information you provide!
Email*
example@example.com
Today's Date*

MonthDayYear
e
Host's Name (if applicable)

First NameLast Name
Have you heard of Arbonne before? Have you used any products?*
Are you currently experiencing any of the following? (check all that apply)*

bloating & indigestion/ stomach discomfort/ digestive issueslow energy/ brain fog/ fatiguepoor sleeplow mood/ unexplained mood swingshormonal acne or other skin concernsdry, dull skinoily, unbalanced skinunwanted weight gain (menopause, post-pregnancy, life)dry, brittle, damaged hairOther
In your ideal world, what would you like to have? (check all that apply)*

a better understanding of my bodyglowing, clear skinbetter energy/ high productivitymore money & travelsustainable healthy habits that I enjoyself confidence & self-peacea career I adorea supportive communitywork/life flow that feels gooda stronger, leaner & more toned physiqueextra money to spend without feeling guiltyOther
Any other concerns not listed? If so, please share / any wellness goals you're currently working towards?
Products that caught your attention? (Check all that apply)*

GreenSynergy ElixirEnergy FizzProteinDaily Essentials Convenience Pack ( Meal Replacement Protein, Fizz, GreenSynergy Elixir)30 Days to Healthy Living Set ResetDermResults Advanced SkincareOther skincare optionsMakeupHair CareBody CareOther
We offer 3 week Trial options for GreenSynergy +Energy Fizz Drink and 5 Step DermResults Advanced collection. Is a Trial something you are interested in?

Yes - GreenSynergy + Energy FizzYes - DermResults AdvancedYes - Both Please!Ask me later
Would you be option to the idea of grabbing a few friends & hosting your own event?*

In home healthy happy hour (wellness bevies & facials)Text/online 48hr pop-up wellness chatAsk me laterI'd rather not host
Is adding an extra income stream soemthing you've considered? If so, how much would make a difference for you?

$200-$500/month$1500 - $4000/month$5000-$8000/month$20,000/month +
On a scale of 1-3, what is your number after learning about Arbonne? (check all that apply)*

1- I am interested in products at a discount, free shipping & free gift options2- I am curious about how the business works & have questions3- The business sound brilliant, how do I join you?Other
I know someone that would be interested in Arbonne? (check all that apply)

Interested in productsInterested in businessInterested in both
Instagram profile and /or Facebook Name - Let's Connect! ex. @christinalamorte/ Christina Lamorte Bazin *
Thanks you!

I appreciate you sharing this information. I will send you a text soon in response to your answers. I look forward to being a part of your Wellness Journey!

- Christina
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Your Wellness Journey Starts Here!