Wellness Survey - Functionally Balanced with Betsy
Please fill out this quick 2-minute survey so I can best serve YOU! - Betsy Stevenson, FDNP
Name
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First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you currently experiencing any of the following? Check all that apply.
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Bloating
Digestive Issues
Low Energy/Fatigue
Anxiety
Brain Fog
Skin issues
Weight loss
Weight gain
Blood sugar imbalance
Hormonal issues
Sleep issues
Mood issues
Headaches
Do you have recent blood work (within 6 months)
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Yes
No
Not sure
Are you familiar with ingredients in food, supplements, and personal care products and how they can affect your overall health?
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I’m an avid label reader and into low-tox living
I’m familiar, but could use some brand suggestions and more info
I’m not familiar with how ingredients affect my overall health
How important is it to you to fix areas you struggle in?
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1- not a focus right now
2
3
4
5- a must, I’m ready for a change
Which ones interest you?! Check all that apply
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A free hormone health mini guide emailed to you!
Product recommendations & Fullscript links for helpful supplements based on your answers above.
Invitations to free classes on topics like hormone health, insulin resistance, nutrition, and more!
21 Day Wellness Reset Nutrition plans or 21 Day Metabolism Makeover Nutrition Plan
Work with Betsy one-on-one with in depth labs that uncover hidden imbalances and stressors in my body!
"Cortisol - A Very Good Place to Start" Course (4 Modules Video Series plus bonus materials) $39
COMING SOON! "The Informed Women's Guide to Hormone Therapy" Course (6 Module Video Series) $89
COMING SOON! "The Gut Wellness" Course (8 Module Video Series plus bonus materials) $89
COMING SOON! "The Thyroid Wellness" Course (8 Module Video Series plus bonus materials) $89
Is there anything else you’re struggling with/would like to share/have questions about?
Would you be interested in a free 20 minute consultant via zoom to see if my services would be a fit for you?
*
Yes
No
Thank you for filling out the survey!
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