Menopause Wellness Survey
I’m so excited to be here with you!! Let’s create a wellness journey together! Your info stays private. I only use it to follow up with your results.
Name
*
First Name
Last Name
Please add your Instagram profile so that I can connect with health tips
Add your Facebook profile (for inclusion in Arbonne’s FREE Healthy living community)
Text Number
*
So I can text your personalized suggestions (no spam)😃
Format: (000) 000-0000.
Who may I thank (friend, host, consultant etc.) for sharing this survey with you? (I would like to send them a thank you gift)
*
First Name
Last Name
What are your top 3 menopause struggles or goals right now? (please describe)
Are you currently experiencing any of the following? (check all that apply!)
*
Dry/tight skin
Reactive/sensitive skin
Irritability/Mood swings
Digestive Issues/bloating
Low Energy/Fatigue
Brain Fog/Overwhelmed easily
Trouble Sleeping/Sleep disruption
Hot Flashes/Night sweats
Joint aches/stiffness
All of the above
Which life stage best describes you right now?
Just dealing with my regular cycle.
Perimenopausal (irregular cycles and hormonal shifts)
Menopause (no period for 13months+,vaginal dryness, low libido, nights sweats/hot flashes, sleep issues, irritability)
Post-menopause (continuation of vaginal dryness, low libido, nights sweats/hot flashes, sleep issues, irritability)
If you have a weight loss goal, what would be your ideal number?
1-10lbs
10-20
20-30
30+
Do you use HRT (Hormone Replacement Therapy) or Injectable's? (select all that apply)
HRT
Injectable GLP-1 for diabetes or weight loss
Both
I would like to learn about natural & complementary alternatives.
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
High Cholesterol HDL/LDL
Digestive issues/Gut health
Injury recovery and healing.
Intermittent fasting
Other
What is your preferred skincare routine “style”
Super Simple (2-3 steps)
Moderate (4-5 steps)
Tell me what you recommend
I 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 sustainable habits … consistency over perfection.
Please tell me about more ways to save and earn free products monthly.
I'd love to talk about creating another stream of income that building a business with Arbonne can create.
Other
Would you help me connect with your circle of health minded friends and family?
*
Yes! I have some friends that I can share this survey with.
I’d like to send a birthday or “thinking of you” gift to my friend
Would you help me spoil my staff?
Other
Are you open to a 15 minute follow up chat? What time of the day in the next couple of days would work?
*
Between 9am to noon.
Between noon and 5pm
Between 5pm to 9pm
What time zone are you in?
*
Please Select
Alaska
Pacific
Mountain
Central
Eastern
Email please … so I can stay in touch and I DO NOT SHARE!!
example@example.com
Thank you for helping me make a big healthy living impact through Inspired Living with Sally & Arbonne!
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