Customer Needs Assessments Survey

Customer Needs Assessments

By sharing a little about your needs, we can create personalized product suggestions for you and your family. We respect your privacy and will never sell or share your information.
General Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Birthday

MonthDayYear
Date
Referred by
Family

SingleIn a RelationshipMarriedChildren
Children Ages (Separate with Comma):
How would you describe your preferred shopping method for Home, Health, and Beauty products? (Select all that apply)

Online OrdersSubscriptionsIn-Person/Retail Stores
How would you prefer to receive product information? (Select all that apply)

Physical CatalogVirtual CatalogProduct Links
What is your preferred contact method? (Select all that apply)

PhoneTextEmail
Home Care

Whether you're looking for safer cleaning options, easier routines, or products that fit your lifestyle, this section helps us understand how to best support your home care needs.
Do you have air or water quality concerns in your home? (Select all that apply)

Air QualityWater QualityMaybe, would like to discuss optionsNA
Which cleaning and home care products are used frequently in your home? (Select all that apply)

Liquid Laundry SoapPowdered Laundry SoapSurface CleanersDisinfectant CleanersDish SoapDish Tablets/Pods
Health & Nutrition

Everyone’s health and nutrition journey looks a little different. What matters most is finding simple, sustainable habits that support your energy, well-being, and long-term goals.
What are your supplement focus areas? (Select all that apply)

Multi-VitaminImmunity SupportFitnessWeight ManagementFocus and AttentionMemory and BrainEnergyHeart HealthBone HealthDigestive Health
Do you take or use any of the following sports nutrition? (Select all that apply)

Pre-WorkoutPost-WorkoutProtein SnacksWhey ProteinCreatineElectrolytesPre-Made ShakesEnergy DrinksEssential Amino Acids (EAA) / Branched-Chain Amino Acids (BCAA)Carb BlockersNA
Flavor Preferences: (Select all that apply)

ChocolateVanillaStrawberryOtherNA
How do your children prefer to take vitamins and supplements? (Select all that apply)

PillGummiesLiquidNA
What are your current beverage preferences? (Select all that apply)

Bottled WaterSoft DrinksTeaCoffeeSparkling WaterEnergy Drinks
Flavor Preferences (i.e. Diet, Caffeine-Free, etc.)
Are there any additional health or wellness areas where you would like support?
Do you have allergies or other food preferences or limitations?
Skincare & Beauty

Whether you're brand new to skincare or already have a routine, this section will help us understand your needs so we can recommend products and routines that truly work for you.
How would you describe your skin? (Select all that apply)

NormalDryOilyBlemish ProneSensitive / AllergiesCombinationOther
If Other:
Please select qualities you would like to improve about your skin: (Select all that apply)

TextureHydrationRednessPore SizeClogged PoresAcneFine Lines / WrinklesAge SpotsDark Circles (under eyes)Excess OilUnsure
Do you have any concerns about the skincare products you currently use?
Please provide the brand information and concern in the available space.
What products do you currently use in your makeup routine? (Select all that apply)

FoundationPowderPrimerMascaraBrow ProductsHighlighterEye LinerBlushConcealerLipstick (Matte)Lipstick (Gloss)Lip GlossNone
Personal Care

From grooming to daily hygiene to self-care rituals, this section helps us understand your personal care preferences so we can recommend options tailored to you.
Which personal care categories are you interested in improving or exploring? (Select all that apply)

Hair CareBody WashOral CareFragranceLotionDeodorantChild SkincareNA
Are you Interested in monthly subscription products or automatic reoccurring orders? (Select one)

YesNoMaybe
Other Comments or Questions:
Thank you for completing our Customer Needs Survey. Your responses help us understand your goals so we can match you with products that genuinely support your lifestyle and wellness priorities. Our team will review your answers and reach out shortly with personalized recommendations or a tailored product shopping list for you to look over. We appreciate the opportunity to support your health, home, and everyday routines.
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Customer Needs Assessments

General Information

Home Care

Health & Nutrition

Skincare & Beauty

Personal Care