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health quiz
i'm so excited that you want to use natural solutions to support your health! essential oils are so powerful and have made huge changes in my family's health- I know you will love them too! this questionnaire will help me get to know you a little better and understand your health goals so that I can help you choose the oils that will best support you! xoxo
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* Indicates required question
first & last name
*
Your answer
mailing address (for sending the samples!)
*
Your answer
email address
*
Your answer
on a scale of 1-10, how would you rate the quality of your sleep?
*
horrible
1
2
3
4
5
6
7
8
9
10
amazing
what, if any, problems do you have with sleep?
*
falling asleep
staying asleep
feeling rested when i wake up
all of the above
none of the above
Required
do you struggle with any chronic pain/inflammation?
*
yes
no
on a scale of 1-10, how would you rate the strength of your immune system?
*
very weak
1
2
3
4
5
6
7
8
9
10
very strong
i feel emotionally unbalanced & frequently struggle with stress & anxiety
*
true
false
do you struggle with depression?
*
yes
no
how would you describe your mental focus?
*
clear & sharp
foggy & slow
Required
how would you describe your energy throughout the day?
*
Your answer
on a scale of 1-10, how would you rate the health of your hair, skin, and nails?
*
not healthy (brittle, dry, & dull)
1
2
3
4
5
6
7
8
9
10
very healthy (hydrated, strong & vibrant)
how would you describe your digestion?
*
i am often bloated
i struggle with a chronic digestive issue (SIBO, GERD, IBS, etc)
i have infrequent bowel movements
Other:
Required
what are your 3 primary health concerns?
*
sleep
chronic pain & inflammation
immune support
emotional support
anxiety/depression
mental focus
lack of energy
hair, skin, & nail health
digestive issues
Other:
Required
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