Please fill out this survey
You will be entered to win a gift card or swag bag for completing this survey. My name is Erika V, and my team and I love to share tools to help people feel better and create a healthier environment. I personally have multiple autoimmune disorders, chronic pain, and allergies, to name a few. I am forever grateful for learning about different ways I could manage my concerns. I can't wait to share Tips with you.
Check off all that apply to you
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Lack of energy
Brain fog
Seasonal Allergies
Achy Joints/ Pain
Cancer Survivor
I would love to lose weight
Sugar cravings
Female Hormones and Mood concerns
GI Issues- reflux, nausea, constipation, etc.
Other
Regardless of the brand, what products/ supplements have you been using daily to help with your concerns above?
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Name
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First Name
Last Name
Do you have Pets?
Please Select
Yes
No
Who can I thank for the recommendation?
Check off all that apply to members of your family or household
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Lack of energy
Brain fog
Seasonal Allergies
Achy Joints/ Pain
Cancer Survivor
I would love to lose weight
Sugar cravings
GI Issues- reflux, nausea, constipation, etc.
Female Hormones and Mood concerns
Other
Regarding Chemicals in your home. Which of these apply to you -check off all that apply.
I would love to go green and healthy.
I know I should change my products, but I am worried about their effectiveness.
I am careful, but some things, such as my hair care, may have slipped through the cracks.
I would love to do an audit to see if there are areas I can improve.
Other
If I were your Fairy Godmother and could grant you 3 wishes regarding your health, what would they be? (e.g., weight loss, achy joints, allergies, GI etc..)
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Occupation
Do you have any allergies, including food? If no type none,
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Cell # in case I have questions
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Please enter a valid phone number.
Email
*
example@example.com
Submit
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