PRODUCT MATCH QUESTIONNAIRE
Let’s find the best protocol for you!
Name
First Name
Last Name
Age
Email
example@example.com
What is your Instagram handle (if applicable)
Ex. oneplantonelove (Follow me!)
What are your main health concerns?
Stress. Anxiousness/Overwhelm. Mood.
Sleep
Digestion/Gut Health
Balanced Hormones/Energy Levels
Aches/Pain
Immunity/Preventative Health
Weight
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 current stress level on a scale of 1-5 (1 being no stress, 5 being stressed to the max)
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
Do you lay awake struggling to fall asleep or wake up in the middle of the night? Y/N?
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
List any dietary restrictions/allergies/sensitivities
How committed are you to feeling better and improving your quality of life?
Extremely
Somewhat
Not very committed
Would a 1:1 consultation, guidance and support be beneficial for you? Y/N?
Submit
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