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Built to Glow: Glow Skin Survey
1
What is the best email we can send your results to?
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example@example.com
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2
Name
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First Name
Last Name
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3
Phone Number
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Please enter a valid phone number.
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4
Address
Street Address
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City
State / Province
Postal / Zip Code
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eSwatini
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Tanzania
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Tokelau
Tonga
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Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
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Ukraine
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Uruguay
Uzbekistan
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Vatican City
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Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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5
Please share your TikTok username to get started:
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6
When you look in the mirror, do you notice any of the following: fine lines, dull-looking skin, or loss of firmness?
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Yes
No
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7
Do you notice your stomach feeling flatter in the morning but more bloated by the evening?
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Yes
No
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8
Are you concerned about hair thinning, shedding, or lack of shine?
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Yes
No
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9
How would you describe your energy most days?
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Steady and Strong
Up and Down
Running on Empty
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10
How would you describe your sleep most nights?
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Deep and Restorative
Inconsistent
I Wake Up Tired
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11
Do you feel like stress has been affecting how you look or feel lately?
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Yes
Somewhat
Not Really
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12
How often are you intentionally moving your body each week?
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5+ Days
2-4 Days
Rarely Lately
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13
Do you currently consume at least 5 servings of colorful fruits and vegetables daily?
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Yes
No
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14
Are you currently supporting your gut health with probiotics, prebiotics, or digestive support?
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Yes
No
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15
Do you currently take any wellness or beauty products that support healthy skin, hair, collagen, or overall wellness from within?
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Yes
No
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16
What wellness products or daily habits are currently part of your routine?
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17
Do you believe how we feel internally eventually shows up externally?
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Absolutely
I'm Starting To
I've Never Thought About It That Way
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18
What matters most to you as you age? (select all that apply)
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Healthy Glowing Skin
Energy
Strength
Confidence
Mobility
Better Recovery
Healthy Digestion
Healthy Hair and Nails
Longevity
Feeling Like Myself Again
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19
Which of these would you most love to experience for yourself?(Select all that apply)
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Glowing Skin
Firmer-Looking Skin
Fewer Visible Lines and Wrinkles
Healthier Hair
Stronger Nails
Better Digestion
Feeling Lighter and Less Bloated
More Energy
Better Wellness Habits
Feeling Stronger in My Body
Improved Confidence
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20
When you picture your healthiest self, what does she feel like?
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21
Tina also mentors women on healthy aging, wellness, confidence, and creating sustainable routines from the inside out. Would you be open to learning more about her wellness program or affiliate opportunities?
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Yes, Absolutely!
Maybe, I am Curious
No Thanks
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