JKY² Wellness 🦋
Let's stop guessing — pick a time that works for you and we'll build your personalized wellness plan together. 🦋
Nutrition & Lifestyle Assessment
This quick wellness check helps me understand your lifestyle, habits, and goals so our conversation is tailored to YOU — no guesswork, no one-size-fits-all. Fill it out, pick a time, and we'll build your personalized wellness plan together on a free 15–20 minute Zoom. This assessment is for wellness education only and is not intended to diagnose, treat, cure, or prevent any disease.
Full Name
*
First Name
Last Name
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
*
example@example.com
Have you had your carotenoid antioxidants tested before?
Yes
No
How much do you know about the role of antioxidants in supporting overall wellness?
Nothing
A bit
A lot
How many servings of fresh fruits and vegetables do you eat per day?
1-2 servings
3-5 servings
5+ servings
How often do you vape/smoke?
Never
Socially
Daily
How often do you exercise?
Never
A few times a week
Daily
On average, how many hours of sleep do you get?
Do you currently take supplements?
Yes
No
If yes, specifically what are you taking?
How much do you / would you invest per day on supplements?
$1
$3
$5
$7+
What's your #1 health/wellness concern?
Additional concerns or areas you want to improve
Immunity
Bloating/Digestive Discomfort
Premature Aging/Brain Health
Stress/Anxiety/Mood
Blood Sugar/Metabolism/Afternoon Crashes
Bone, Joint and Skin Health
Vision/Eye Health
Sleep quality
Heart Health
Do you know anyone who would benefit from a free personalized health assessment?
Are you local to the Upstate South Carolina area? (Walhalla, Seneca, Clemson, or Oconee/Pickens County)
*
Yes
No
Pick a time below — here's how it works: 🦋 LOCAL (Upstate SC): We can meet in person for your scan. In-person visits are nonrefundable, but that $20 will be applied toward your product purchase after the meetup. 💻 NOT LOCAL (or prefer virtual): Your 15–20 minute Zoom consultation is complimentary.
Schedule your in-person wellness scan
Schedule a Zoom wellness call
Pick a time for your complimentary 15–20 minute Zoom consultation
Email
example@example.com
Appointment
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Appointment
This is a fill in the
blanks
field. Please add appropriate
blank
fields and text.
Anything else you'd like me to know before our call?
Submit & Book My Consultation
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