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HEALTH GOALS CHECKLIST
Helping 100 people find REAL-LIFE health solutions 🌿 For each section, check all area(s) which most concern you.
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We’re helping 100 people reach their health goals!
🌿 Our 7 Healthy Habits Focus ✅Community ✅Nutrition ✅Supplementation ✅Hydration ✅Movement ✅Silence ✅Sleep
First Name
Last Name
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2
💪 ENERGY, STRENGTH & PERFORMANCE
(All that apply)
Low daily energy or fatigue
Poor sleep or difficulty waking up
Muscle soreness or joint aches
Trouble building or maintaining muscle
Slow recovery after workouts
Low motivation or endurance
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3
❤️ HEART, METABOLIC & WEIGHT HEALTH
(All that apply)
High blood pressure
High cholesterol
Blood sugar imbalance or prediabetes
Frequent cravings or energy crashes
Weight gain or belly fat
Family history of heart disease
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4
🧠 MIND, MEMORY & MOOD
(All that apply)
Brain fog or forgetfulness
Low mood, anxiety, or irritability
Difficulty focusing or staying motivated
Feeling disconnected or isolated
Stress eating or emotional fatigue
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5
🌸 HORMONES, MENOPAUSE & LONGEVITY
(All that apply)
Hot flashes or night sweats
PMS or irregular cycles
Slower metabolism after 40
Low libido or energy
Trouble sleeping through the night
Feeling “off” hormonally
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6
🍏 DIGESTION & GUT HEALTH
(All that apply)
Constipation or irregularity
Bloating or indigestion
Low stomach acid or poor nutrient absorption
Food sensitivities or discomfort after meals
Gas, reflux, or sluggish digestion
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7
💧 IMMUNE, SKIN & INFLAMMATION
(All that apply)
Frequent colds or low immunity
Skin irritation, eczema, or acne
Allergies, asthma, or sinus issues
Stiff joints or inflammation
Slow wound healing or easy bruising
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8
🏡 ENVIRONMENT & FAMILY WELLNESS
(All that apply)
Concern about household toxins or cleaners
Kids’ nutrition or focus issues
Sensitive skin reactions to soaps or detergents
Wanting safer options for home or pets
Desire to create a healthier home environment
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9
🧘♀️ MINDSET, SILENCE & STRESS
(All that apply)
Difficulty relaxing or shutting down
Difficulty finding time for self-care
Constant mental overload
Poor sleep quality or racing mind at night
Desire for better daily rhythm or peace
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10
✳️ YOUR GOALS
(All that apply)
Lose weight
Gain strength
Improve digestion
Sleep better
Balance hormones
Feel more joyful and balanced
Reduce inflammation
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11
Phone Number
For your personalized REAL LIFE action plan & be entered in the drawing.
Please enter a valid phone number.
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12
Best Time To Connect
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Evenings
Weekends
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