Form Consultation
Hi!! Feel free to fill out the form if you're wanting to improve on how you feel from the inside out. This is for me to understand you and provide the information you need. I'm here to help :) - Bri Bjorgan
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Do you want info on promos via text (approx 1 time a month)?
Yes please!
Not right now, thank you
Instagram Handle
What demographic are you?
Please Select
Teenager
Young Adult
Adult
Aging Adult
Senior
How familiar are you with "clean" wellness / beauty products and how they can affect your health?
Not familiar
1
2
3
4
Clean Icon
5
1 is Not familiar, 5 is Clean Icon
Supplement Section
What are your primary health and wellness goals? Check all that apply.
weight management
increased energy
better sleep
improved digestion
stress reduction
clearer skin
anti-aging
fitness goals
other... (fill out in a couple questions)
On a scale of 1-5, how satisfied are you with your current overall health?
Unhappy
1
2
3
4
Happy
5
1 is Unhappy, 5 is Happy
What do you currently experience? Check all that apply.
bloating
digestive issues
low energy/fatigue
autoimmune disorders
anxiety
brain fog
fertility issues
trouble sleeping
trouble losing weight
other...
If you answered "other" to the questions above, please expand here! :)
Do you currently take any supplements?
Yes
No
Skin Section
Are you currently satisfied with your skin?
Yes
No
Could be better
How would you describe your skin type?
Dry
Oily
Combination
Normal
Sensitive
Are you experiencing any of these common skin issues? Check all that apply.
acne
fine lines/wrinkles
dryness
uneven skin tone
dull skin
eczema
rosacea
other
Makeup Section
What makeup products are you most interested in? Check all that apply.
foundation
skin tint
concealer
eyeshadow
mascara
lip products
blush
bronzer
primer / setting spray
makeup remover
How heavy do you like your makeup?
Barely there
1
2
3
4
Full on baby
5
1 is Barely there, 5 is Full on baby
Final Steps!
Is there anything else you're wanting to share or have questions about??
Would having a 20 min consultation call be helpful for you?
Yes please!
I'm okay, thank you
Yes, and I would like to hear about the business side too
Submit
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