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HEALTH ASSESSMENT - KimberlyHalinen.com
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Name
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Email
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What Country do you Live in?
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USA
Canada
Australia
New Zealand
Mexico
Other:
What areas of your health would you like to focus on first?
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What areas of your health would you like to focus on first?
I am sick of fad diets & quick fixes! I want to maintain a healthy weight by getting to the root of the problem.
I am looking for something to help my entire family stay healthy year round.
I would love to balance my hormones, improve my immunity and my gut health!
I would love to improve the health of my skin, reduce wrinkles, lines and dark spots. I want to look GOOD
I am struggling with these health issues... (check all that apply)
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Sugar
Poor Sleep
Weight Gain
Headaches/Migraines
Low Energy
Mood Swings
Auto-Immune Disease
Constipation
Bloating
Acid Reflux
Acne
Hormone Imbalance
Anxiety
Sinus Inflammation
Thyroid Dysfunction
Other:
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Are you interested in becoming a VIP Customer? VIPs receive 25% off their supplements. There is a $9.95 enrollment fee for your first year and $19.95 annually after that.
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Yes, I love a good deal!
No, thank you. I will pay full price.
Are you interested in using your referral link to upgrade to a Brand Ambassador? Earning income with my coaching and guidance? There is a $39.95 annual fee.
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Yes, I'd love to earn some extra income!
No, thank you.
How did you find me?
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