PRODUCT MATCH QUESTIONNAIRE
Let’s find the best protocol for you!
Name
First Name
Last Name
Age
Email (needed for assessment results)
example@example.com
What is your Instagram handle (if applicable)
Ex. @oneplantonelove (Follow me!)
What are your main health concerns?
Mood–Stress/Anxiety/Depression
Sleep
Digestion/Gut Health
Hormone Balance (peri/menopause)
Aches/Pain
Immunity/Preventative Health
Weight Management
All of the above
Other
What are your biggest obstacles when it comes to your wellness routine?
Time
Money
Motivation/Accountability
Consistency
Belief
Other
What is your main health goal?
How physically active are you?
Extremely
Somewhat
Very little
How many hours of sleep do you get on average?
7-9 hours
5-6 hours
Less than 5 hours
What is your wellness budget?
Minimal (less than $100)
Moderate ($100-250)
Accelerated wellness ($250+)
There is no price tag to health!
Varied from month to month
How committed are you to feeling better and improving your quality of life?
Extremely
Somewhat
Not very committed
List any dietary restrictions/allergies/sensitivities and/or any medications you’re currently taking.
Do you have any specific questions? ASK HERE:
Congratulations on taking the first step to advocating for your health!
Check your inbox (and spam folders) for your assessment results/product match, within 24 hours. Feel free to message Amy at: oneplantonelove@gmail.com
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