Wellness Survey
wellness is not a trend; it's a timeless investment in yourself. make it a lifestyle.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is your IG Handle? I would love to follow you!
Are you currently experiencing any of the following? Check all that apply.
Bloating
Digestive Issues
Weight Gain
Low Energy / Fatigue
Brain Fog
Trouble Sleeping
Hormonal Issues
None of the above
Other
If you checked other, please explain
Are you currently satisfied with your skin?
Yes
No
Could be better
Are you experiencing any of these common skin issues? Check all that apply
Signs of aging
Fine lines/wrinkles
Dark spots/uneven skin tone
Dry Skin
Oily Skin
Acne
Dull skin/lacking glow
None of the above
Are you familiar with ingredients in your wellness and beauty products and how they can affect your overall health?
I am familiar but I don't really care
I am somewhat familiar but could use more info
I am really familiar and all about the low-tox life
I am not familiar with you how ingredients affect my overall health
Are you familiar with gut health and how this can affect overall health, your skin and your mental health?
I am familiar but could use more info
Yes! I am a gut health enthusiast
No
My goal is to help as many people as I can thrive in their life. What's your favorite way to receive information? Check all that apply
Text
Email
What areas of your life would you like to improve? Check all that apply
Overall Health & Wellness
Community/Friendships
Income/Financial Stability
Mindset/Mental Health
Are you open to hopping on a quick 10 min call to discuss your survey?
Sure
No thanks
Submit
Thank you!
Im excited to partner with you on your road to wellness! - Kylar
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