Arbonne Wellness Survey
We are so excited to be here with you!! Let’s create a wellness journey together!
Name
*
First Name
Last Name
Please add your Instagram profile so that we can connect with health tips.
Add your Facebook profile (for inclusion in our FREE Healthy living community).
Text Number
*
We will send you suggestions here based on your answers 😃
Format: (000) 000-0000.
Who can we thank (friend, host, consultant, etc.) for sharing this survey with you? (We would like to send them a thank you gift!)
*
First Name
Last Name
What are your top 3 health struggles or goals right now? (Please describe.)
Are you currently experiencing any of the following? (Check all that apply.)
*
Weight Gain
Hormone shifts
Irritability/Mood swings
Difficult periods/Irregular periods
Bloating
Digestive Gut Issues
Anexiety/Depression
Low Energy/Fatigue
Brain Fog/Overwhelm
Trouble Sleeping/Sleep disruption
Hot Flashes/Night sweats
Joint Pain
Food Noise
All of the above
Women's focus: Which life stage best describes you right now?
Just dealing with my regular cycle.
Trying to get pregnant.
Pregnant or Postpartum
Perimenopausal (irregular cycles and hormonal shifts)
Menopause (no period for 13months+, vaginal dryness, low libido, night sweats/hot flashes, sleep issues, irritability)
Post-menopause (continuation of vaginal dryness, low libido, night sweats/hot flashes, sleep issues, irritability)
N/A
If you have a weight loss goal, what would be your ideal number (in pounds)?
1-10
10-20
20-30
30+
Are you familiar with gut health and how this can affect your overall health, your skin, and your mental health?
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I'm familiar, but could use more info.
Yes, I'm a gut health enthusiast!
Not at all.
Do you use HRT (Hormone Replacement Therapy) or Ozempic ? (Check all that apply.)
HRT
Ozempic
Both
I would like to learn about natural alternatives.
N/A
Are you experiencing any of these common skin issues? (Check all that apply.)
Acne
Oily skin
Dry skin
Signs of aging
Fine lines and wrinkles
Dark/Age spots
Dull skin/lacking glow
Other
What other areas of your life/health are you most concerned about and interested in? (Check all that apply.)
*
Reading labels
Shifting to cleaner ingredients
Immune system recalibration
A1C/Blood sugar balance
High blood pressure
IBS/Ulcerative Colitis/Crohns
High Cholesterol HDL/LDL
Digestive issues/Gut health
Injury recovery and healing
Skin care (anti aging, dryness, oily, etc)
Sports nutrition and support
Nutrition/skin ideas for kids and teens
Intermittent fasting
Other
We want to help you grow in your healthy living journey! (Check all that apply)
*
I’d love an invitation to your FREE healthy living community on FB.
I’d love to get recommendations based on my answers.
I’m interested in creating some simple sustainable healthy habits with Arbonne!
Please tell me about more ways to save and earn free products monthly.
I would love to get a 35% discount on my next purchase.
Please send me info on how to earn a little extra $ by simply sending out surveys to my connections.
I'd love to talk about the financial independence that building a business with Arbonne can create. I'm ready for more in my life!
Would you help us connect with your circle of health minded friends and family?
*
Yes! I have some friends that I can share this survey with.
Sure, how about 3-4 friends at my house to sample and chat?
I'm not up for a party at my house or a survey, but I would love to bring a couple of friends to your next event!
Let's do coffee with my bestie!
I'm super busy right now, but check with me in a few weeks.
I’d like to send a birthday or “thinking of you” gift to my friend
Would you help me spoil my staff?
Can you help me order and wrap gifts for my Holiday gift giving?
Other
What areas of your life do you want to improve? (Check all that apply!)
Overall Wellness
More Community/Friendships
Extra Income/Financial Stability
Mindset/Mental health
Other
What time of the day in the next couple of days would work for a 15 minute follow-up chat?
*
Between 9am and noon.
Between noon and 5pm
Between 5pm to 9pm
What time zone are you in?
*
Please Select
Alaska
Pacific
Mountain
Central
Eastern
Email please.
example@example.com
Please share your address so that we can mail you a thank you gift and samples!
Mailing Address
City
State
Zip
What else should we know about you?
Thank you for helping us make a big healthy living impact through Arbonne!
Submit
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